Dental Charity Foundation Grant Application

Use this form to apply for funding from the Dental Charity Foundation. Your event must be focused on oral health education or charitable dental care. Priority for funding is given to student-led organizations, but other requests will be considered. Up to $500 in funding is typically granted with larger grants possible if deemed appropriate. Documentation of the event must be submitted after the event has occurred in the form of receipts, a summary of how the event was successful and at least one photo - please email this to Funding will be disbursed after receipt of this email either via Chase Quickpay or check.

Your organization's name and description:
What are you seeking funding for?
Please include event description, the date(s) and location of the event, whom the event is benefiting, what specifically you need money for and any additional sources of funding. Requests for funding for items that are actually contributing to health care (e.g. toothbrushes/toothpaste) are given priority as compared to ancillary expenses (e.g. food/gasoline). Be thorough but succinct.
How much funding do you estimate that you will need?
You may itemize your anticipated expenses if it makes it easier to calculate. If actual expenses are less than your approved funding, we will reimburse you for the combined dollar amount on the receipts.
Contact Name:
Contact Phone Number:
Contact Email:
Contact Address:
Only include if you wish to be mailed a check.