Service Dog Placement Application

Service Dog Placement Application
This application is the first step in determining alignment for service dog placement.

Placement is not based on need alone.
It is based on compatibility between dog and handler, as well as commitment to the training process.

Please answer each section thoughtfully.
All applications are reviewed individually.
Name

First NameLast Name
Email
example@example.com
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What type of support are you seeking from a service dog?
YesNo
Conditional (if YES): Please briefly describe your experience
Describe your current living environment (home type, household members, other animals, etc.)
Type a question
What does a typical day look like for you?
Low (mostly home-based)ModerateActive / frequently outside the home
YesNo
How do you typically respond when something is not working as expected?
What does a successful partnership with a service dog look like to you?
YesNot at this timeI would like to discuss further
Why do you feel a service dog is the right fit for you at this time?
Should be Empty: