Eternal Smiles Foundation Grant Application Pre-Screen

  • Eternal Smiles Foundation Grant Application Pre-Screen

    Complete this form to determine if you are an eligible grant applicant.
  • Is the child between 11-17 years old?*

  • Based on the information submitted, you are currently ineligible for this program at this time.

  • Does the child live in a single parent household (a family unit where one parent, whether a mother or father, is primarily responsible for raising one or more children without the presence of a spouse or partner in the same household)?*

  • Based on the information submitted, you are currently ineligible for this program at this time.

  • Is the child currently wearing braces?*

  • Based on the information submitted, you are currently ineligible for this program at this time.

  • Are you at or below the maximum household income threshold of 2x the national poverty level for the prior calendar year (link below)?*

  • HHS Poverty Guidelines for 2026

  • Based on the information submitted, you are currently ineligible for this program at this time.

  • Are you able to pay the required $50 nonrefundable processing fee to begin your application, and submit ALL required documentation by 5/31/26? NOTE: This is a nonrefundable, tax-deductible processing fee. Submitting this fee does NOT guarantee selection.*

  • Based on the information submitted, you are currently ineligible for this program at this time.

  • Based on your responses, you do not currently meet the eligibility requirements for this program. If you believe any information was entered incorrectly, please review and update your answers before proceeding.

  • Should be Empty: