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Smiles For Teachers

First Name

Last Name

Phone Number

School Name

School City

School State

Grade

Subject

How did you hear about the Smiles For Teachers program?

Other

Who is your general dentist?

When did you have your last cleaning appointment

Why are you applying for this smile makeover?

Tell us a little about the current state of your teeth.

In one sentence, please tell us why you became a teacher, and what keeps you coming back day after day?

Please make sure you are clicking the upload button after you have selected your file(s).

Submit a photo where we can see the current state of your teeth.

Click Here to Upload

Should you become a finalist, submit a photo that we will use on our website during the voting period.

Click Here to Upload

Below are the updated Terms and Conditions for the Smile For Teachers program. Please indicate that you have read and agree to the updated Terms and Conditions.

I have read and agree to the Terms and Conditions of the Smile For Teachers program (listed below).

I agree

Click here to review the Official Terms & Conditions .

You are required to fully review the Official Terms & Conditions of the Smile For Teachers Program prior to submitting your initial application.