Child Referral

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If you wish to refer a child under 18 years of age please complete this form.

You will be contacted by a member of the referral committee within three business days.

All information is kept strictly confidential.

First Name *

Last Name

Address 1

Address 2

City

Zip

State

Day Phone

Evening Phone

Email *

Comments *

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Our Sponsors

Who We Are

Sparks of Hope is a nonprofit organization geared toward children who are survivors of physical or sexual abuse.
We are an all volunteer, non-profit organization.

Reach to Us

Sparks of Hope 1819 SW 5th Avenue, No. 303 Portland, OR 97201: Phone:
(503) 592-0096; E-mail: chris@sparksofhope.org