Application

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If you need dental help and meet the qualifications, please complete the form below. If you need to know more information about eligibility and process, please see this page.

Select your state:(Required)

We are ONLY accepting applications in the following counties. If your county is not listed, we cannot accept your application at this time.

Autauga
Barbour
Calhoun
Clarke
Dallas
Etowah
Franklin
Lauderdale
Madison
Mobile
Morgan
Russell
Talladega
Tallapoosa
Tuscaloosa

All counties are OPEN to new applications.

We are ONLY accepting applications in the following counties. If your county is not listed, we cannot accept your application at this time.

Coconino
Navajo
Pima
Yavapai

We are ONLY accepting applications in the following counties. If your county is not listed, we cannot accept your application at this time.

Clark
Columbia
Dallas
Montgomery
Searcy

Due to lengthy waitlists, all counties are CLOSED to new applications.

We are NOT accepting applications in the following counties. If your county is listed, we cannot accept your application at this time.

Alamosa
Bent
Huerfano
Rio Grande
San Miguel
Sedgwick
Yuma

We are NOT accepting applications in the following counties. If your county is listed, we cannot accept your application at this time.

Litchfield

Due to lengthy waitlists, all counties are CLOSED to new applications.

We are ONLY accepting applications in the following counties. If your county is not listed, we cannot accept your application at this time.

Miami – Dade
Orange

Due to lengthy waitlists, all counties are CLOSED to new applications.

Due to lengthy waitlists, new applications are NOT being accepted from the following islands. If your island is listed, we cannot accept your application at this time.

Kauai
Maui

On the Big Island we are ONLY accepting applications in the following cities. If your city is not listed, we cannot accept your application at this time.

Honokaa
Kailua-Kona
Kealakekua
Waimea (or Kamuela)

We are ONLY accepting applications in the following counties. If your county is not listed, we cannot accept your application at this time.

Ada
Bonneville
Canyon

We are ONLY accepting VETERAN applications in the following counties. If your county is not listed, we cannot accept your application at this time.

Twin Falls

Due to lengthy waitlists, new applications are NOT being accepted from the following counties. If your county is listed, we cannot accept your application at this time.

Adams

We are NOT accepting applications in the following counties. If your county is listed, we cannot accept your application at this time.

Clark
Floyd
Harrison
Jackson
Jefferson
Lawrence
Madison
Miami
Monroe
Morgan
Pike
Ripley
Scott
Vanderburgh
Warrick
Washington
Wayne

All counties are OPEN to new applications.

We are NOT accepting applications in the following counties. If your county is listed, we cannot accept your application at this time.

Butler
Geary
Harvey
Miami
Montgomery
Russell
Osage
Osborne
Pawnee
Reno
Rooks

We are ONLY accepting applications in the following counties. If your county is not listed, we cannot accept your application at this time.

Boone
Fayette
Grant
Kenton
Madison
Scott
Warren

We are ONLY accepting applications in the following parishes. If your parish is not listed, we cannot accept your application at this time.

Ascension
Assumption
Bossier
Caddo
De Soto
East Baton Rouge
East Feliciana
Iberia
Iberville
Jefferson
Lafourche
Livingston
Orleans
Plaquemines
Pointe Coupe
Red River
St. Bernard
St. Charles
St. Helena
St. James
St. John the Baptist
St. Mary
St. Martin
St. Tammany
Tangipahoa
Terrebonne
Washington
West Feliciana

We are ONLY accepting applications in the following counties. If your county is not listed, we cannot accept your application at this time.

Cumberland
Kennebec
Knox
Oxford
Piscataquis
Sagadahoc
Somerset
Waldo
York

All counties are OPEN to new applications.

We are ONLY accepting VETERAN applications in the following counties. If your county is not listed, we cannot accept your application at this time.

Bristol
Essex
Middlesex
Norfolk
Plymouth
Worcester

All counties are OPEN to new applications.

All counties are OPEN to new applications.

We are ONLY accepting applications in the following counties. If your county is not listed, we cannot accept your application at this time.

Bolivar
Forrest
Hinds
Jones
Lafayette
Lamar
Lauderdale
Leflore
Lincoln
Lowndes
Madison
Rankin
Sunflower
Tate
Warren

We are ONLY accepting applications in the following counties. If your county is not listed, we cannot accept your application at this time.

Clark
Cole
Henry
Knox
Laclede
Lewis
Livingston
Marion
Osage
Pettis
Phelps
Platte
Pulaski
Scotland
Vernon

We are NOT accepting applications in the following counties. If your county is listed, we cannot accept your application at this time.

Cascade
Custer
Missoula
Yellowstone

Due to lengthy waitlists, all counties are CLOSED to new applications.

Due to lengthy waitlists, all counties are CLOSED to new applications.

We are NOT accepting applications in the following counties. If your county is listed, we cannot accept your application at this time.

Ocean County

All counties are OPEN to new applications.

We are ONLY accepting applications in the following counties. If your county is not listed, we cannot accept your application at this time.

Broome
Dutchess
Fulton
Genesee
Herkimer
Livingston
Monroe
Oswego
Putnam
Rockland
Steuben
Wayne
Westchester
Wyoming
Kings
Nassau
New York
Queens
Richmond
Suffolk

We are ONLY accepting applications in the following counties. If your county is not listed, we cannot accept your application at this time.

Buncombe
Carteret
Gaston
Mecklenburg
Moore
Randolph
Wake

We are NOT accepting applications in the following counties. If your county is listed, we cannot accept your application at this time.

Benson
Bottineau
Burleigh
Cass
Dickey
Emmons
Morton
Sargent
Ward

Due to lengthy waitlists, all counties are CLOSED to new applications.

We are ONLY accepting applications in the following counties. If your county is not listed, we cannot accept your application at this time.

Clackamas
Deschutes
Lane
Marion
Multnomah
Washington

Veteran applicants are encouraged to apply in all counties.

All counties are OPEN to new applications.

We are ONLY accepting applications in the following counties. If your county is not listed, we cannot accept your application at this time.

Berkeley
Charleston
Dorchester
Georgetown
Laurens
York

All counties are OPEN to new applications.

We are ONLY accepting applications in the following counties. If your county is not listed, we cannot accept your application at this time.

Anderson
Davidson
Greene
Johnson
Knox
Madison
Maury
Montgomery
Rutherford
Sullivan
Washington

Due to lengthy waitlists, all counties are CLOSED to new applications.

We are NOT accepting applications in the following counties. If your county is listed, we cannot accept your application at this time.

Salt Lake*

*Except for those who are 60+ years of age.

All counties are OPEN to new applications.

We are ONLY accepting VETERAN applications in the following counties. If your county is not listed, we cannot accept your application at this time.

Clark
King
Snohomish
Spokane

Due to lengthy waitlists, all counties are CLOSED to new applications.

We are ONLY accepting applications in the following counties. If your county is not listed, we cannot accept your application at this time.

Cabell
Hancock
Harrison
Kanawha
Mercer
Monongalia
Ohio
Upshur

Due to lengthy waitlists, all counties are CLOSED to new applications.

We are ONLY accepting applications in the following counties. If your county is NOT listed, we cannot accept your application at this time.

Albany
Fremont
Sweetwater
Teton
Uinta
Washakie

Please check one or more of the below options that applies to you:(Required)

Over 65 years of age

Permanently disabled

Has medical documentation that dental care is required

None of the above

According to eligibility requirements, you do not seem eligible for the DDS program. Please go to your state’s dental association to receive a list of public dental assistance and sliding scale clinics. You may also search for a community health center near you that offers dental care by going to https://findahealthcenter.hrsa.gov/

Are You a Military Veteran?(Required)

Yes

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