Personalized Academy of Learning (PALS) Therapy Dog Interest Form
Thank you for your interest in welcoming a PALS therapy dog into your home. This form helps us begin the interview process and better understand your family's need for a potential therapy dog placement.
Meet Beni the Mini Sheepadoodle!
Beni is a Mini Sheepadoodle with an expected adult weight of 25–35 lbs. This unique breed combines the intelligence of the Poodle with the gentle, affectionate nature of the Old English Sheepdog—making Beni an ideal candidate for therapy work. Mini Sheepadoodles are known for their calm demeanor, intuitive sensitivity, and eagerness to connect, offering the perfect blend of brains, beauty, heart and being hyperallergenic. Beni is a natural at bringing warmth, comfort, and stability to those he meets, making him an excellent fit as a therapy dog.
Applicant Information:
Full Name
Phone Number
Format: (000) 000-0000.
Email Address
example@example.com
Home Address
Do you own or rent your home?
Own
Rent
If renting, do you have permission to have a dog?
Yes
No
Therapy Support & Household Overview
Who is the dog intended to support?
Age of the individual receiving support
Your relationship to them
Does the individual have a diagnosis of formal therapeutic need?
Autism Spectrum Disorder (ASD)
Anxiety
Depression
PTSD or Trauma
Sensory Processing Disorder
Developmental Delay
Physical Disability or Mobility Challenge
Other
No formal diagnosis, but there is some therapeutic need
What do you hope the therapy dog will help with? (E.g. emotional regulation, transition support, anxiety reduction, companionship)
Do any household members have dog allergies?
Yes
No
If yes please explain
Pet Experience, Daily Routine & Environment
Do you currently have other pets?
Yes
No
Temperament
Species
Have you owned a dog before?
Yes
No
If yes please describe
How many hours per day will the dog be home alone (with no people present)?
less than 2 hours per day
between 3-5 hours a day
between 5-8 hours a day
more than 8 hours a day
Do you have a fenced yard?
Yes
No
Care Commitment & Training
Are you prepared for the financial responsibilities of owning a therapy dog (food, grooming, vet care, etc)?
Yes
No
Are you prepared to attend mandatory weekly training sessions after adoption? (dates to be determined)
Yes
No
Are you open to follow-up training or support if needed?
Yes
No
Veterinary Care Current or Preferred
Clinic Name
Phone
Format: (000) 000-0000.
Are you committed to providing regular veterinarian care (vaccinations, wellness visits, and emergencies)
Yes
No
Professional Reccommendation Requirements
Before your interview can be scheduled, please submit one letter of recommendation from a professional who is familiar with the individual receiving therapy. Acceptable references include a therapist, occupational or speech therapist, teacher, case manager, pediatrician, or family physician. Please email the letter to: therapydogs@ptherapy.net
Agreement By Signing Below:
I confirm that the information provided is accurate. I understand this is an interest form only and does not guarantee placement. I agree to provide a professional letter of recommendation prior to interview.
Signature
Date
/
Month
/
Day
Year
Date
Questions?
Email therapydogs@ptherapy.net
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