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Access to Care Eligibility Questionnaire
Submission failed due to the following:
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Are you a tax-exempt entity under 501(c)(3) of the Internal Revenue Code?
Yes
No
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Are you a public or governmental entity such as a school or health district?
Yes
No
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Are you a Tax-exempt dental association?
Yes
No
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Do you provide dental services to the underserved population?
Yes
No
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Are you located within and/or would funds benefit people living in our operating area?
(Alabama, California, Delaware, District of Columbia, Florida, Georgia, Louisiana, Maryland, Mississippi, Montana, Nevada, New York, Pennsylvania, Texas, Utah, West Virginia)
Yes
No
