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Referral Inquiry Form

This inquiry form is the first step to receiving a wish – it is not confirmation of eligibility for a wish. Your information will be forwarded and you will be contacted by a member of our wish-granting team.

WHO CAN REFER A CHILD?

Make-A-Wish accepts referrals from:
  • Children being treated for a life-threatening medical condition
  • Parents or legal guardians
  • Medical professionals (typically a doctor, nurse, social worker or child-life specialist)
  • Family members with detailed knowledge of the child's medical condition

Who is eligible?

A child with a critical illness who has reached the age of 2½ and is younger than 18 at the time of referral is potentially eligible for a wish.

Read more on eligibility criteria for a potential wish child.

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Make-A-Wish® Mississippi
607 Highland Colony Parkway
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Ridgeland, MS 39157
(601) 366-9474
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Make-A-Wish® Mississippi, Southern Region - Gulfport
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