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  • Smile for a Lifetime Online Application

    The information in this application is needed to fulfill your request for assistance with orthodontic treatment. We may share this information with orthodontists, dentists, or other dental professionals to process your scholarship application. Once you have completed the application, please review carefully before you submit. Information is not saved and must be completed in one sitting. Please return the Dental Clearance Form, Letter of reference, Report Card, Proof of Income and Facial Photos by email to Info@SmileForALifetime.org or by fax to 719-312-6000. If all the needed information is not submitted within 30 days, you may be required to start the application process over. The approval process can take 6 to 12 months from the time you have turned in ALL the needed paperwork. The application process is competitive and not all qualified applicants will be guaranteed a scholarship. 
  • APPLICANT'S PERSONAL INFORMATION

  • PARENT/GUARDIAN’S PERSONAL INFORMATION

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  • DENTAL INFORMATION

  • GENERAL INFORMATION

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