Teledentistry in Schools Learning Collaborative| Application Form

Please complete the application below to be considered for the teledentistry in schools learning collaborative by November 18, 2022.

Up to three clinics will be selected to participate. Catalyst staff will inform all applicants of their status in December 2022. Refer to the Teledentistry in Schools Learning Collaborative webpage for more information and project details.

For questions, contact Ericca Facetti.

  • Clinic Information

  • Use this link to determine if your clinic is located in a DHPSAs in Virginia: https://data.hrsa.gov/tools/shortage-area/hpsa-find
  • 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.

  • 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!