School-Based Oral Health Learning Collaborative| Application Form

Please complete the application below to be considered for the school-based oral health program (SBOHP) learning collaborative by September 23, 2023.

Up to four clinics will be selected to participate. Catalyst staff will inform all applicants of their status by late September 2023. Refer to the SBOHP project description webpage for more information and project details.

For questions, contact Ericca Facetti.

SBOHP 2023-2024 Learning Collaborative Application

  • Clinic Information

  • Use this link to determine if your clinic is located in a DHPSAs in Virginia:
  • Use this to connect with new or different schools in your service area. If you don't have a preference, you can leave this space blank.
  • This includes clinical staff, administrative support, previous experience, equipment, etc.
  • Dental sealants must be included.
  • Participant Information

    Please include contact information for the individuals from your clinic who will participate in this project and represent the clinic at meetings. It is important to build a multidisciplinary team for projects such as this to balance the duties, gain different perspectives and input, and strengthen the sustainability of your work. Possible team members could include dental staff, administrative/front desk staff, clinic executive, or data/IT staff. At least two people must be included on the application, but more are encouraged!