Create A Smile Dental Foundation was formed in 2003 to help low income people pay for dental workThere are 47 million people without health insurance and many more without dental insurance. For a lot of people dental care is a luxury, that takes a back seat to rent, car payment, electric bills, food, etc. I formed this Foundation with the purpose of creating an entity where people who have experienced dental problems and know what folks go through with dental pain, and now have the means to help others, can find a place to donate money.
Our Mission is to raise funds to help low income people pay for dental work. We are a not-for-profit, chraritable organization. We are also incorporated in the State of Illinois as a Charitable Organization.
We have many success stories, the last being Carla Fletcher from Grand Tower, Illinois. Ms. Fletcher came to us with points for teeth. We paid to have all her teeth extracted and dentures. Carla now has a beautiful smile. (I am working on her pic to put here)
We paid for Danny McKane to have all his teeth extracted. All of his teeth were rotten and causing him excrutiating pain a majority of the time. He lives on pain killers. Danny told me, "John, I feel better now than I have felt since I was 12 years old."
Listing of successes:
#13......Examination and cleaning,(child had tooth cavity in baby tooth, parents were assured nothing could be done by JALC)
#10......Root Canal on 12 year old girl plus restorative dental work (filling instead of crown)(Dr. Todd and Br Butt)
#74......Examination and sent back to public aid for work because of no pain(Dr. Butt)
#75.....Tooth extracted(Dr. Butt)
#18.....Exam and cleaning (2 children) by Dr. Butt
#19.....Cleaning and exam(no cavities, she thought she had a mouthful) (JALC)
#70.....Paid for tooth extraction (Dr. Butt)
#76.....Paid for tooth extraction(Dr. Butt)
#5......Child (paid for exam JALC)
#31....Exam and cleaning (JALC)
#52....attempted extraction(Dr. Butt(
#76....Baby exam (Paducah Ky dentist Dr. Largent)
#84…22 year old man…All teeth extracted by Dr Gustave (Carbondale Oral Surgeon)
#101… 52 year old man…all teeth extracted…University Place Dental Center
#107…82 year old woman…dentures relined… University Place Dental Center
#115…18 year old West Frankfort boy needed $250.00 for a dental procedure not paid by medical card…we paid that fee
#140…9 year old girl…2 teeth extracted…Dr. Breeden…Benton, Il.
#142…61 year old woman…abscessed tooth treated and then extracted… University Place Dental Center
#164…60 year old woman….all teeth extracted & dentures….U.P. Dental CenThe above is some of the work accomplished by our Foundation
Create a Smile Dental Foundation
115 S. Division St Suite A
Carterville, Il. 62918
(618)925-2140
e-mail: jflora1947@yahoo.com
Webpage: www.casdf.net
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copy and paste the application and send to above address
Application #_________ (to be filled out by Foundation)
Hello: Thank you for your interest in our Foundation. The mission of this Foundation is to help people get needed dental care. We have a rather extensive questionnaire to find out information vital to your individual needs. Please answer all the questions and if you have any questions call the Foundation. We may be spending hundreds, even thousands of dollars to remedy your dental situation, so we want to find out your needs, both dental and financial. If you already have a dentist, we wish to utilize your dentist. Talk to your dentist, tell them about this Foundation and ask them if they will work with us. We will pay them if you are approved. You may present this letter to the dentist if you like. A letter from the dentist will help in our evaluation of your dental needs. With this application for assistance we ask that you become a part of the Foundation by helping at some of the fundraisers. Please also fill out an application to become a member of the Foundation and help us to help you. There is no charge to become a member if you are a working member. There is a great variety of volunteer work to be done to make this Foundation a success and that is what we all should strive for. Any questions about any of the application or the application to become a member, call me at 925-2140. Please start the application process and fill out all the blanks of our application: The following application is for people in Williamson, Jackson, and Franklin Counties in Southern Illinois only.
Name__________________________________________
age________ Sex_______ Address_________________________________________
Date of birth___________ City_________________________________State______ Zip_______ Phone____________ Total monthly income$_________ Date of application_______08
Please return cover letter, application, and membership application to: Create A Smile Dental Foundation
115 S. Division St
Carterville, Il. 62918
Guidelines CASDF
1. Our guidelines will be on an individual basis, $1200.00 per month gross amount qualifies for assistance when the funds are available, if rule # 1 is met.
Families add $300.00 per month per family member. For example a family of three with a gross income of $1800.00 can qualify.
2. We will not pay for braces for purely cosmetic reasons, if there is a medical reason, they will be considered.
3. Dentures will be paid for but we will shop around and find the least expensive place to buy them.
4. We want you to help us raise funds to help you.
The more you do for the Foundation, the quicker you can obtain dental help. There are many ways to help us to help you. You can volunteer at our Thrift Store, have a yard sale and donate the proceeds to CASDF, talk to your church about having a benefit for CASDF, or come up with ideas on your own about fundraisers. We have various fundraising projects throughout the year that you can help with.
We have bucket brigades ( you can organize your own and donate the proceeds) walkathons, contests, and a variety of other fundraising projects.
5. If we get info you to tell you about a fundraiser and you help us, you will automatically move up the list to be helped.
If you are not able to help, try to find a friend or relative to take your place at fundraisers. We have approximately 160 people on our list, very few help us, so even if you are #160, you can move to #1 very rapidly, if you choose to help us.
It is your choice how fast you would like dental help. Application for Membership
Member #________ (we fill this out)
___________________________________________ ________________________
name phone
__________________________________ __________________________ ________
address city zip
______________
age
Tell us how you would like to assist the Foundation:
Dental assistance application
Completely fill out the application.
If you have questions call at 925-2140 or come by the office at 115 S. Division St. and we will help you.
What barriers have kept you from having dental work done? Financial, fear, transportation, family issues, etc..
What are your dental problems? Be specific. ( example: Need tooth extracted, need dentures, need all teeth extracted, need fillings, etc)
Do you have an estimate on the cost of your dental work? If yes, how much? $_________
Do you have a regular dentist, if yes, name and address.
How often do you have toothaches, and how often do you miss school / work for this reason?
Pain scale from 1-10 with 1 being the lowest?
Are your teeth problems affecting your general health? If yes, how?
Why are you asking for assistance?
What have you done to get assistance?
Are you on Public Aid, Medicare, Medicaid or any other assistance programs? If yes, which program?
Do you have health insurance?
Do you have a medical card or Kid Care?
Are you able to pay anything towards your dental work?
Are you willing to travel to have dental work done?
Will you need assistance in finding transportation?
How did you find out about this organization?
Are you afraid of dentists?
If approved will you follow through on your part, that is, keep all of your appointments, and follow through until the work is complete?
One of the requirements for assistance is to become a part of the Foundation by volunteering time at fundraisers and other foundation functions. The more you help the Foundation, the more money we can make, and the quicker the funds are available to help you. The more you help the faster you move up the list
Employment and Financial
Are you employed? By whom?
How many years?
Who were your last 3 employers?
Employer name and address?
What is your monthly household income? $_______
How many in household? _______
What are the total of your monthly bills? $__________
Do you own your home? Yes( ) No ( ) House payment? $________
Do you rent? _____ How much is your rent? $_______
Landlords name and address.
Do you have any of the following:
Checking account ( ) Savings accounts( ) balance $________ Credit Cards( ) balances $_________ payment $___________ Bonds, CDs or other savings accounts( ) balance $________ Child support( ) Receive or pay? Alimony( ) amount$____________ SSI / Disability( ) amount of annuity$_____________
If we call you for an interview bring the above listed items that pertain to you, also, drivers license or state picture ID, pay stubs for last two months, electric bill, and a list of your monthly bills plus any letters of denial for dental work.
Personal
Age______ Male or female____ Birth date___________ What is your highest level of education?
Are you in school now? Where?
Four character references, not family. Names, addresses, and phone numbers.
Write a paragraph explaining why you think the foundation should grant your request for assistance. Attach a sheet if needed.
