Service Dog Application

Service Dog Application

Please note: traveling to Aspen, CO is required as part of our training program. $150 nonrefundable application and consultation fee must be received before application will be processed. Background checks will be required on all adults in the household.
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According to the ADA, “Service animals are defined as dogs that are individually trained to do work or perform tasks for people with disabilities. Service animals are working animals, not pets. The work or task a dog has been trained to provide must be directly related to the person’s disability. Dogs whose sole function is to provide comfort or emotional support do not qualify as service animals under the ADA.”
Name and age of individual in need of a SD*

First NameLast Name
Name of person filling out this form (if someone other than disabled applicant)

First NameLast Name
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
What are you applying for:*

A task trained Service DogTraining with a dog I currently ownFacility DogOther
What is the disability with which the Service Dog can assist? A disability is defined by the ADA as a physical or mental impairment that substantially limits one or more major life activities, a person who has a history or record of such an impairment, or a person who is perceived by others as having such an impairment.*
Tasks you believe a dog can perform to assist with disability. (What tasks are a challenge for you or are you incapable of doing for yourself.) If applying for a facility dog - how could a dog help your patients/ students?*
Have you ever had a Service Dog before?*
Have you had a dog before? Tell us about them.*
What medical equipment do you currently use to assist with your disability?*
How does the disability affect your life and current level of independence?*
Please tell us about you (lifestyle, job, activities, home life)*
If you are hoping to train your own dog, please give as much detail about the dog, including: breed, age, level of training, temperament, any behavior issues...
If you are hoping to train your own dog: A large percentage of dogs fail out of training for various reasons. What is your back-up plan for yourself and the dog if the dog ultimately doesn’t qualify?
Do you have the resources to care for a dog? (time, money, patience) Expenses can range $3k - 5k annually. You must keep on top of your Service Dog's training - working and exercising them daily along with check-up training with us.*
Average Yearly Income for the last 3 years.*
Current or most recent employer (name, address, phone)*
Owning and training a Service Dog is a lifestyle. It takes commitment and prioritizing your dog's well-being and training. Your SD is medical equipment, not just a pet, and will be trained and treated differently. This means structure, control, and manners which may include no furniture and not socializing with all your friends and other dogs. Do you understand this?*
Do you understand that it can take 6 months to 2 years to have a fully trained, public access ready SD?*
Are you allergic to dogs?*

yesno
List any and all pets in your home*
What would having a Service Dog mean to you and the limits in your life due to your disability?*
How much do you feel you could honestly afford for a medical Service Dog, without causing financial hardship, while also taking into consideration the value of a Service Dog and the donor's generosity and goodwill. Keep in mind, Service Dogs cost an average of $50,000.*

I have no $ available for a dogUp to $5,000Up to $10,000As much as neededOther
Do you have the ability to assist with fundraising and applying for grants?*
Do you have the ability to volunteer with our organization (cleaning kennels, washing dishes, stuffing Kongs, brushing dogs, passing out fliers...)?*
How did you hear about us?*
Personal Reference (name, number, relation):*
Have you ever been convicted of a felony? If so, please explain:
Vet Reference:*
Doctor or Psychiatrist (name, number):*
Farrah is not easy to acquire as a service dog trainer due to her high standards & ethics. Farrah must believe that you have a strong need for the dog and that you will abide by the laws and be compliant and committed to the training. We also expect you to participate in ongoing training and community connection activities with EP Service Dogs. If Farrah accepts you as a candidate, she will put her heart and soul into helping you have the best dog possible. Do you give your word that you have an honest need for a SD based on an ADA defined disability?*
You must submit a background check if you are seeking a Service Dog from our organization. You must submit Doctor and/or Psychiatrist letters before or at your interview. Acceptance into our program does not guarantee reciept of a SD or your dog becoming a certified SD. Each step is taken one at a time and at any point either party can determine that we are not the right fit for your SD journey.
$150 Application and consultation fee must be received before application will be processed. We will schedule your consultation after processing application and payment.
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