Giving Partner Submission

Tell us about yourself and your organization

Organization Name*
Name*
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Your role*
How did you hear about us?*
Email*
Your website*
How long has your organization been involved in oral health education*
- 0 to 2 years
- 2 to 5 years
- 6 to 10 years
- 10 or more years
Please summarize your program, including the number of people involved both patients, audiences, and staff.
What do enjoy most about what your organization does?
What do you enjoy least about what your organization does?
Do you currently have sponsors for your organization? If so list them here along with any other organizations that are affiliated with you
Tell us what countries, regions, and/or states your program operates and tell us what is your current focus, demographic or otherwise.
Describe the impact your education effort has on those you serve.
Have you used StarSmilez in your organization before?*
- Yes we use them now
- We have in the past
- StarSmilez has not been part of our program
Other notes

Only registered community users can give award!