• Smile for Seniors Foundation Assistance Application

    Thank you for your interest in assistance through Smiles for Seniors Foundation. Please complete this application and upload all required documents. Submission of an application does not guarantee assistance. Assistance is subject to eligibility requirements and available funding.
  • Are you a California resident?*
  • Are you 65 years of age or older?*
  • Is your monthly household income $3,000 or below?*
  • Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Format: (000) 000-0000.
  • Which type of assistance are you seeking?*
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  • Upload a File
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