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Community Care Award Application
Our Mission
This award is designed for students whose families face financial barriers that make treatment otherwise unattainable.
Who Can Apply
- Ages 13–19
- Demonstrated financial need
- Good dental hygiene standing
- Willing to commit to orthodontic treatment
Please read the entire application carefully before beginning. This is a comprehensive application, and all required materials must be prepared in advance. Your progress will not be saved, and the application must be completed and submitted in one session.
Applicant Information
First Name
Last Name
Date Of Birth
Current School
Current GPA
How did you hear about the program?
Guardian Information
Please provide contact information.
First Name
Last Name
Date Of Birth
Address
City
State
Zip Code
Phone
Email
Written Statements
Please upload your essays in one document answering the following two questions:
1. Describe the orthodontic problem you have and explain how correcting it would affect your daily life at school, at home, and with others. (250 word minimum)
2. Orthodontic treatment is a commitment that takes time and effort. How would you take care of your braces or aligners and keep your appointments? (250 words minimum)
PDF or DOC format accepted.
Essays Upload
Upload
or drag files here
Letter of Recommendations
Please upload letters from teachers, counselors, or school administrators who can speak to your academic effort, character, or community involvement.
Guidelines:
PDF format preferred
Letters may be written within the last 12 months
Upload Letter of Recommendation #1
Upload
or drag files here
Upload Letter of Recommendation #2
Upload
or drag files here
Most Recent Transcript
Upload your most recent school transcript or report card. An official transcript is preferred but not required.
Acceptable documents include:
Recent report card
Official or unofficial transcript
Screenshot or PDF from the sc
hool portal
PDF, PNG, JPG files accepted.
Most Recent Transcript
Upload
or drag files here
Proof of Financial Need
Please upload
one
documentation to help us understand your family’s financial situation. All information is kept confidential and used solely for scholarship review.
One
of the following:
Recent tax return (Form 1040, first page only; you may redact SSNs)
Free or Reduced Lunch eligibility letter
Government assistance documentation (SNAP/Medi-Cal/SSI/TANF)
PDF, PNG, JPG files accepted.
Proof of Financial Need Upload
Upload
or drag files here
Intraoral Photos
To properly evaluate your application, we require clear orthodontic screening photos. These images allow Dr. Luke to assess alignment, bite relationships, and overall treatment complexity.
What You’ll Need
Smartphone with rear camera
Bright lighting or Flash enabled
Plain background
Two clean spoons (to retract cheeks)
A helper (strongly recommended)
Smile Profile Picture
Upload
or drag files here
Frontal Smile Picture
Upload
or drag files here
Right Side Picture
Upload
or drag files here
Left Side Picture
Upload
or drag files here
Upper Occlusal Picture
Upload
or drag files here
Lower Occlusal Picture
Upload
or drag files here
Please Read and Agree Below
Patient/Legal Guardian Signature
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