Service Dog Training Application
I am filling this application out on behalf of:
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Myself
Other
If other, what is your relationship to the applicant?
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Applicant's Legal Name
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First Name
Last Name
Applicant's Chosen Name
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Applicant's Pronouns
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he/him | she/her | they/them | other
The applicant is 18 years or older
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Yes
No
Birthdate
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-
Month
-
Day
Year
Date
Email
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example@example.com
Phone Number
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-
Area Code
Phone Number
Applicant's Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Disability(s) that limit one or more of your major life activities:
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How does your disability(s) impact your life?
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How will a Service Dog help you?
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Have you had a Service Dog before?
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Yes
No
If yes, where did you receive your previous Service Dog?
Are there any pet animals in the household?
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Yes
No
If there are other animals in the household, please list details below: Species, Breed, Age, Sex
Program I am most interested in:
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Foundation Training
Advanced Training and Task Training
Full-Service Program
I'm Not Sure
How much dog handling/husbandry experience does the applying handler have?
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A GREAT DEAL: I have significant hands on experience with caring for and handling dogs and am confident in my skills.
A MODERATE AMOUNT: I have a moderate amount of experience with handling dogs but am not fully confident with all aspects of caring for a dog.
NONE AT ALL: I will need significant help in learning about canine husbandry and handling.
How much dog training experience does the applying handler have?
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A GREAT DEAL: I have trained multiple dogs to high levels of obedience and have significant training experience.
A MODERATE AMOUNT: I have trained 1-3 dogs to obedience skills such as sit, down, stay but do not know how to train advanced skills.
NONE AT ALL: This will be my first time training a dog and I have no prior training experience.
How much outside support will you need to train and care for your dog?
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A GREAT DEAL: My disabilities impact me to a point that I am unable to train a dog without assistance. I will need serious hands on help with training and caring for my service dog and being the primary trainer of my dog is unreasonable.
A MODERATE AMOUNT: I will need some extra help in caring for and training my dog but my disabilities do not interfere with my ability to train the tasks that I need but could do with some accommodation. .
NONE AT ALL: My disabilities do not interfere with my ability to train, care for or exercise my dog.
How much outside support do you have?
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A GREAT DEAL: I have a significant amount of outside support and have people to help with training and caring for the dog.
A MODERATE AMOUNT: I have people who can sometimes assist with training and caring for the dog.
NONE AT ALL: I do not have any outside support or assistance in caring for and training my dog.
How much time do you have to commit to working with and training your dog?
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A GREAT DEAL: I have a significant amount of time each day to be with and actively work with my dog.
A MODERATE AMOUNT: I have at least 30 minutes of time each day to work with my dog.
NONE AT ALL: I barely have time for things outside of my current commitments and do not see being able to take time out of my day to work with and train my dog.
Do you have a dog already?
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Yes
No
Dog's Info
Dog's Name
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Dog's Breed(s)
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Dog's Age
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Dog's Weight
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Dog's Sex
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Intact Male
Neutered Male
Intact Female
Spayed Female
How long have you owned your dog?
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How did you acquire your dog?
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Has your dog ever shown signs of aggression to any human or animal?
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Yes
No
If your dog has shown aggression to a human or other animal, please explain:
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I understand that participating in an evaluation or interview does not guarantee me a spot in a program.
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I understand
Submit
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