College Puppy Raiser Application

ACTS - Assistance Canine Training Services
2928 East Conway Road
Center Conway, NH 03813
603-383-2073

IMPORTANT INSTRUCTIONS: Please read carefully

Please use your TAB key to move on to the next entry box.

You must fill out this entire form in one session. If you leave your form will NOT be saved.

Date*

Date

Name*

First NameLast Name

School Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Physical/Shipping Address (if different from above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Cell Phone*

Area CodePhone Number

Home Phone

Area CodePhone Number

School Email*

example@example.com

Personal Email (non-school)*

example@example.com

Expected Date of Graduation (Month/Year)*

example@example.com

College or University*

State College or University is Located*

What name do you prefer we use for correspondence and certificates?*

Dog Training Experience

Have you ever personally obedience trained a dog?*

YesNo

Have you ever taken any dog training classes?*

YesNo

Have you ever had the primary responsibility of raising a puppy?*

YesNo

Please comment on the above dog training questions.*

College Living

What year are you in?*

FirstSecondThirdFourth

If you are in your first year, what semester are you in?*

FiirstSecondOther

Are you in an undergraduate or graduate program?*

If you have declared a major, what is it?*

If you have a declared minor, what is it?*

What is your estimated graduation date? Year and what semester?*

Please explain your current living arrangements and your future plans for living arrangements? (Dormatory? Off campus housing? Pet friendly?)*

Do you have a roommate or roommates? Please explain.*

Do you live with any other pets? Please explain.*

Do you work full or part time while on campus? Please explain.*

Do you own your own vehicle or have access to a car for training sessions and veterinary visits? Please explain.*

Please include a copy of your current class schedule

Browse Files

Your Family

Is everyone in the family in agreement about puppy raising for ACTS?*

YesNo

Is anyone in your immediate family allergic to dogs?*

YesNo

Do you go home for the summer? Do you go home for breaks?*

Do you work full or part time during the summer? Please explain.*

Have you spoken to your family about the possibility of bringing a puppy home for breaks or for the summer? Please explain.*

When you travel home, if you cannot fly with your puppy, is driving an option? Please explain. *

If you brought your puppy home for the summer or breaks, how many hours on average would your puppy be left home alone? Please explain.*

If you brought your puppy home for the summer or for breaks, would you be able to commit to weekly virtual training sessions?*

Please give us some information about the dogs you have in your home.

	Species	Name	Age	M/F	Neutered?

Do all your dogs live inside?*

YesNoNo Other Dogs

Please list any other household pets you have.*

Please list any outdoor animals you have.*

Please give us your history of dog ownership. Include what kinds of dogs, what became of them, obedience training completed, and any other pertinent information. If you were actively involved with any childhood dogs, please include them as well.*

Other

How soon can you commit to raising a puppy?*

Please talk about any preferences regarding breed or sex that you may have and why. ACTS is willing to work with puppy raiser preferences but please keep in mind that specific requests can potentially delay the placement process.*

Please tell us why you would like to be a puppy raiser for ACTS.*

Are you a smoker?*

YesNo

Does anyone living in your family home smoke?*

NoYes, one otherYes, more than one other

If there are smokers in the household, do they smoke in the house or in the car? Please explain.*

References

Your references should help us decide if you have the character we require to receive one of our dogs. You should select people who are NOT your immediate family. References who can specifically speak to your character, your previous volunteer experience, your willingness to learn and take on a challenge, your ability to fullfill commitment, or your abilities as a dog owner are particularly helpful.

First Reference

Name*

First NameLast Name

Phone Number*

Area CodePhone Number

Email*

example@example.com

Relationship to applicant*

Second Reference

Name*

First NameLast Name

Phone Number*

Area CodePhone Number

Email *

example@example.com

Relationship to Applicant*

Third Reference

Name*

First NameLast Name

Phone Number*

Area CodePhone Number

Email*

example@example.com

Relationship to Applicant*

Are you willing to follow the rules and regulations for puppy raising as outlined by ACTS?*

Yes

Are you willing to attend the required practice sessions?*

Yes

Do you feel you are emotionally prepared to handle the separation when the puppy is ready to leave you for its final training?*

Yes

Are you willing to represent ACTS appropriately as outlined by their policies and procedures?*

Yes

ACTS requires our volunteers carry auto liability insurance on all personal vehicles that transport ACTS dogs. Do you carry personal auto liability insurance?*

Yes

I acknowledge that by submitting my name and signing below, that all the above information is accurate.

Name*

First NameLast Name

Please Sign and Submit*