Career Change Application Request

KSDS Assistance Dogs, Inc.
120 W 7th St.
Washington, KS 66968

785-325-2256
Fax: 785-325-2258
snutsch@ksds.org

KSDS Assistance Dogs, Inc. is a non-profit organization that trains and places guide dogs for the blind and visually impaired, service dogs for the physically disabled, and facility dogs to work alongside professional educators. The dogs used for the program are screened and tested on their physical qualities, trainability, how well they adjust to new environments, and temperament. Some dogs will not pass these entire tests. They are released and available for adoption. Other dogs available for adoption can include a retired guide, service, or facility dog. These dogs are all in need of a stable and loving home.

To place your name on file as being interested in adopting a released or career change dog, please complete the following so we can create the best match for you and the dog.

Check your dog preferences. *

List any physical qualities you will NOT accept.

Applicant Name *

First Name Last Name

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Home Phone *

Work Phone

Mobile Phone

E-mail *

Number of family members in the household. *

Number of children in the household. *

If there are other pets in the household, describe them.

Reference Name *

Reference Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Reference Phone *

Veterinarian Name *

Veterinarian Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Veterinarian Phone *

Describe why you would like to adopt a Career Change dog from KSDS Assistance Dogs, Inc. Include information about yourself, family, environment, hobbies, and activities. *

KSDS Career Change Dog Application