Service Dog Connection Fund Application
Apply for the Service Dog Connection Fund by providing your information below. Please pay the $20 application fee before submitting your application.
First Name
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Last Name
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Please enter your phone number.
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Please enter your email.
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Please enter your address.
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Have you been a New Mexico resident for two years or longer?
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Please Select
Yes
No
Please upload two proofs of New Mexico residency.
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Proof of Diagnosis/Doctor's Note must be provided by your doctor or therapist stating a diagnosis has been made. Military documents showing a diagnosis will also suffice.
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Do you already have a dog that you would like evaluated as a potential service dog?
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Yes, I have a dog that I would like to be considered and evaluated.
No, I do not have a dog.
Please describe your service dog needs.
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Please provide a bio and some photos for the fund committee to review when your application goes up for a vote. It is up to you if you would like us to share your story with our audience but we do require this for our internal process.
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I agree that my application will be reviewed by the fund advisory committee that includes representatives of Dog Training Elite New Mexico and other community members who represent the aging, physical/mental disability and veteran populations.
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Yes, I agree.
No, I do not agree.
I understand and agree that if I am selected, I must attend a 1-hour Orientation ($150 non-refundable) to go over ADA law, rights, responsibilities and how to care for your Service Dog. This will go into the fund.
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Yes, I agree.
No, I do not agree.
I understand that all dogs in the program must be up-to-date on all vaccinations, flea/tick prevention, and deworming, as necessary. If your dog is diagnosed with any communicable condition (fleas, ticks, worms, illness), you must notify trainers immediately.
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Yes, I agree.
No, I do not agree.
I understand that an internal background check on all applicants after receiving all documents and a completed application is required.
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Yes, I agree.
No, I do not agree.
I understand that if approved, there is a fundraising goal between $1-4k, depending on the level of service training needed. This level has been set by our fund committee to show a level of commitment to the training plan and care required for a service dog.
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Please Select
Yes, I agree.
No, I do not agree.
Have you applied to the state program that will pay for service dog training and certification - NMDVR's Rehabilitation Program?The main goal of the program is to support people with disabilities to be able to work.*
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Yes, I applied and am awaiting determination.
Yes, I applied and I was denied.
No, I have not applied but I will do so.
No, I have not applied and will learn more.
Are you currently a recipient of the DDSD Waiver or the Mi Via Waiver which may be used to pay for service dog training and certification?
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Please Select
Yes
No
Please describe how a service dog would improve your quality of life and your health.*
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Please describe some of the potential challenges of having a service dog?
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Please describe where your service dog will live and what a typical day looks like for you and your service dog.
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