Apply For Braces

If you have determined that your child is a good candidate for our program, you are now ready to begin the application process. The application can be completed online or offline.

BEFORE you begin though, there are several required documents that will be submitted as part of the application process. Having them at the beginning of the process will save you time and help with planning.

  • Dental Referral Form (DRF)
  • Photos Required (download instructions and examples)
  • Child’s Essay (This is an opportunity for your child/the applicant to describe in their own words why it is important for them to get braces and what it will mean to them personally.)
  • Federal Income Tax Return or Supplemental Security Income Awards letter (Financial and Tax Info)
  • Check website to determine current wait time for your area

Complete application offline – print, complete and mail application:

The actual application is only two pages long, but you will notice that the download also contains instructions, a checklist to help you complete the application fully, some consent forms and a document that you will need your dentist to complete.

link to download scl application
NOTE: SCL only accepts the current version of our application. Download a current application by clicking the button above. In addition, all applications received will be subject to the most current fee structure regardless of the fees specified on the application submitted.

Complete application online:

While the online application can be done on a cell phone, you will find it easier and possibly faster if done on a desktop PC.

We have also compiled an Application Checklist to follow that explains the required items in greater detail. We recommend you review the Program & Application Process Overview before you begin the online application.

SCL online application button
When your application arrives at the SCL office, it will be reviewed to determine if it is complete and if your child meets our program’s requirement guidelines. In some cases, the applications are submitted to a review panel. Those that are determined to qualify, will be notified via both US Mail and through email. This process can take up to three weeks. Please be patient. Should there be any missing or incomplete information, your application will be returned with an explanation.


Do you live in Coffey, Lyon or Osage County in Kansas? Please visit our Jones Foundation page to download an application for braces.