Additional Tax Information For Children Applying For Our Orthodontic Program

Qualification for our program requires a total taxable household income at or below our financial guidelines as listed at  Please note: It is YOUR responsibility to determine if you meet these financial qualifications before applying. Your application will be denied and your fee will NOT be refunded if your income does not qualify. [Foster parents or agencies that are applying for a child do not need to submit proof of income. Learn more]

You MUST submit a copy of the most recent year’s Federal Tax Form 1040 or Supplemental Security Income award letter as proof of income [USA] or a Notice of Assessment (NOA) and a Canada Child Benefit (CCB) form for Canada. (note: we do not accept Social Security benefits letters as proof of income).  If you do not file Form 1040 or receive Supplement Security Income [US] or a Notice of Assessment and Canada Child Benefit [Canada], your application will NOT be approved. We DO NOT accept any other type of proof of income. Tax forms/SSI awards letters that are altered in any way, including removing/blacking out Social Security numbers, will NOT be accepted. If you are submitting applications for more than one child, you MUST include a copy of your tax form(s)/SSI awards letter with EACH application.

If submitting Form 1040, please note:

  • The child applying for treatment MUST be listed as a dependent on page 1 of Form 1040 or on an additional statement of dependents along with the child’s Social Security number.
  • If the child is NOT claimed as a dependent on your tax return, you must explain why and ALSO submit the tax return for the person who DOES claim the child, as well as proof of where the child resides (e.g. school records). In this situation, both tax returns must meet our income qualifications.
  • Page 2 of Form 1040 (line 10) must show taxable income at or below our financial guidelines listed .
  • If your income does not require you to file taxes, but you are legally allowed to file, you must do so in order to apply for our program, even if your income is $0.

Click here to see an image of the tax form and information needed.

*** Additional documentation for non-parental guardians:

  • Non-parental guardians must also submit a copy of their authorization to make medical decisions.
  • For children in state custody, copies of the child’s state medical card and medical consent must also be submitted.

Do You Qualify For The SCL Program? Find Out Now