Licensed FDM Application

Licensed FDM Application

Please make sure you you have read all information related to Licensure.
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Name (if applicable)
Business Name
Website Address (if applicable)
Website Address
Have you completed the LEGS course*

YesNo
When did you complete the LEGS course

MonthDayYear
Date
Have you seen the Total Welfare Talk?*

YesNo
If you answered “No” to either of the previous two questions, please pause here. To qualify for the licensing program, you’ll need to have both the course and the required talk finished by July of the year before the January licensing window (6 months in advance). This ensures you’ll have the foundation you need to get the most out of the program. If you’re not quite there yet, you are welcome to apply in the next window once everything is complete.
*First time applicants only choose one division*

**Current LFDMs select all that apply**
Division Applying For:*

BehaviorTrainingVeterinaryWorkingShelteringHandlingSupport Pros
Have you read all information related to the divisions and their requirements?*

YesNo
Please list relevant credentials and how long you have held them. Please see the licensure document for required credentials for each division. If you do not have one that is listed. Please list the similar credential here and also send information about it to info@familydogmediation.com*
Credentials
Please tell us about all of your education (dog related and other.)*
Education
Please tell us about other experiences you have had that you feel relate to FDM, LEGS, and/or Total Welfare. Please feel free to share personal experiences, apprenticeships, and volunteer opportunities. Please include specific time frames related to these experiences.*
Experiences
A licensed Family Dog Mediator (LFDM) is an individual who has successfully completed the LEGS Applied Ethology Professional course as well as someone who has seen Kim Brophey's Total Welfare talk. A LFDM is able to demonstrate a clear understanding of the application of the LEGS Model in their respective professional field. How do you put what you learned in the course into action in your work? Please list as many examples as you feel are appropriate.*
Explain how you put it into action:
How do you currently participate in the FDM community? (attending Q&As and Deeper Dive meetings (live or watching them later), participating in the Facebook groups, connecting with other FDMs, etc.)*
Participation
Please only answer this collection of questions if you are applying for the Training and/or Behavior Divisions. We are not looking for perfection but rather a basic understanding of the importance of applied ethology to training/behavior cases.
Why does LEGS and Total Welfare matter in the training/behavior world?
Are you able to describe how you would approach a training/behavior case with a LEGS lens?
The LFDM community thrives on our ability to collaborate both within our individual divisions as well as with the other divisions. We are looking for team players who are willing to collaborate in conversations during meetings, strategizing, project development, and outreach efforts. We will never require you to do anything that you are uncomfortable with. We want our members to use their strengths whatever they may be! Please give us at least one example of a successful collaboration you have had.*
Example of a successful collaboration.
Describe how you might spread the message of LEGS and Total Welfare?*
Message
What inspires you about Family Dog Mediation?*
Inspiration
What else do we need to know about you in order to appreciate all that you have to offer this movement? What do you see as your unique potential or helpful contributions to the conversation and paradigm shift in the pet dog world towards a more welfare centric LEGS Model?*
Tell Us More!
Division Meetings are held once or twice per month (depending on the division.) Are you able to commit to at least one division meeting per quarter at a minimum?

YesNoI'm not sure
Do you agree to check your ego at the door?*

YesNo
Should be Empty: