| |
Give Back A Smile Application and Information
-
Adult women and men who received injuries from a former intimate partner or spouse.
-
A survivor whose injuries are to the teeth. The program does not replace work that has been already repaired through previous enrollment in the GBAS program or by the survivor’s own dentist.
-
Individuals that have been out of the abusive relationship for over one year. Applications will be accepted prior to the one-year mark but will be placed on a waiting list until the requirement has been met. Applicants are responsible for updating the GBAS program with all contact Information.
-
All applicants must have at least one interview to connect them with local resources, to confirm that the injuries were caused by domestic violence, and that the applicant has been out of the abusive relationship for at least one year. A signature from the counselor, advocate, social worker, or case manager must be provided on the application for acceptance into the program.
-
A survivor whose smile is compromised due to domestic violence, and not due to previous neglect. The dentist makes the final determination of this aspect.
How Does it Work?
- Potential applicants call (800) 543-9220 to receive an application for the GBAS program.
- Leave their name, mailing address and telephone number including area code.
- An application will be sent to them through the mail or they can download a copy from the website (www.givebackasmile.com).
- The AACD will contact a participating dentist in the applicant’s area to ask if he/she will accept the case.
- If accepted, the AACD will contact the applicant with the referral.
- It is the applicant’s responsibility to contact the dentist for an appointment.
- The volunteering dentist makes the final determination of eligibility for the program.
- Not showing up for appointments, or last minute cancellations may result in disqualification.
|
About AACD 
