Home
Programs
Materials
About
Blog
Contact
Search for:
Women
My Life. My Plan: Teen.
My Life My Plan: Women.
Healthy Moms
Healthy Women. Healthy Babies
Her Story
Men
Man Up Plan Up
Teens
My Life. My Plan: Teen.
Family
Home Visiting Old
Help Me Grow
2-1-1
Safe Sleep
Healthy Smiles
Family Shade
Community
Get Involved
Thriving Communities
Peer Education
Dream Wall
Providers
Dream Wall
Home Visiting Provider
Safe Sleep Provider
DHMIC
About
History
Committees & Membership
Strategic Initiatives
Resource Center
Annual Summit
Meeting Information & Materials
Smile Check School Form
Smile Check School Form
School/Organization/Facility
*
Contact Person for program coordination
Name
*
Phone
*
Email
*
Person authorized to approve participation with program (Example: Superintendent, Director, CEO, Owner)
Completing this form authorizes a dental professional from the Bureau of Oral Health and Dental Services to reach out to your designated contact to discuss program options and schedule an event at your location.
Name
*
Date
*
Signature
Clear
Submit
Δ
Events
No Events Scheduled
RSS
Want the latest DEThrives updates from our blogs? Subscribe to the
RSS feed
!
Order Materials