[Secure Form] Wisdom For Wisdom 2025 (BOMS)

Wisdom For Wisdom

I am a student over the age of 18.

I am a parent of a student under the age of 18.

Student First Name

Student Last Name

Parent First Name

Parent Last Name

Phone Number

Student's Birth Date

Student's Preferred Pronouns

City

State

Select applicant's current educational status

Current School Name

Current School City

Current School State

What College/University do you play to attend? (optional)

If graduating, what college/university do you plan to attend? (optional)

How did you hear about the Wisdom For Wisdom program?

Other

Who is your general dentist?

When did you have your last cleaning appointment?

Have you been advised by a medical professional to have your wisdom teeth removed?

Our Wisdom For Wisdom program is designed to offset college expenses by providing a complimentary wisdom teeth removal procedure. As a student or parent of a student, what would the Wisdom For Wisdom program mean to you if you are selected?

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

Click here to review the Official Terms & Conditions .

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

I have read and agree to the Terms and Conditions of the Wisdom For Wisdom Program (listed above).

I agree