VetPets of SWPA: Service Dog Application

1

Name* This field is required.

First Name

Last Name

2

Phone Number* This field is required.

Area Code

Phone Number

3

Email* This field is required.

example@example.com

4

Address* This field is required.

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

5

Are you a veteran or first responder?* This field is required.

YESNO

6

Are you willing to commit to completing 3 levels (6-weeks each) of our Service Dog Prospect Program at your own expense, logging 60 hours of training with your dog outside of class, and meeting these requirements before applying for grant assistance?* This field is required.

YESNO

7

Your commitment is essential for the success of both you and your dog in the Service Dog Prospect Program. Completing the required classes and training hours will help ensure you're fully prepared for the next steps. We look forward to supporting you on this journey.

8

We appreciate your honesty. While you do not qualify for grant assistance at this time, you are still welcome to complete the program at your own cost. If your situation changes and you meet the requirements in the future, you may reapply for the grant.

9

Are you willing to allow a VetPets of SWPA trainer to assist in the selection of your Service Dog Prospect and/or evaluate your existing potential prospect?* This field is required.

YESNO

10

Allowing a VetPets of SWPA trainer to assist in the selection and/or evaluation is a crucial step toward ensuring your success in the program. Without this support, we are unable to provide further assistance in the process. Should circumstances change, we encourage you to reapply.

11

Are you willing to speak with our counsellors prior to your initial interview?* This field is required.

YESNO

12

Speaking with our counselors is a vital step in preparing for your initial interview and setting you up for success in the program. Without this conversation, we are unable to proceed. Should circumstances change, we encourage you to reapply.

13

Has a medical professional told you that you are disabled?* This field is required.

YESNO

14

Can you provide supporting documentation from your medical professional?* This field is required.(required within 48 hrs. of appointment)

YESNO

15

Service Dog Prospect Program Ineligiable

Thank you for your interest in our service dog program. As part of our application process, we require documentation from a medical professional confirming your disability and need for a service dog. This ensures that we can appropriately match individuals with a dog trained to assist with their specific needs.

Unfortunately, if you are unable to provide the required documentation, we will not be able to proceed with your application for a service dog.

Therapy Dog Program Eligiblity

However, we would love to offer you the opportunity to participate in our therapy dog program, which focuses on providing comfort, companionship, and emotional support in various settings. While therapy dogs do not perform specific service tasks, they can offer great benefits for overall well-being.

If you are interested in learning more about our therapy dog program or have any questions, please let us know. We appreciate your understanding and look forward to finding the best way to support you.

16

What diagnosis/symptoms affect daily functioning?* This field is required.

17

How long are these symptoms expected to last?* This field is required.

18

Do you receive Social Security Disability ?* This field is required.

YESNO

19

Can you provide supporting documentation for your Social Security Disability?* This field is required.(required within 48 hrs. of appointment)

YESNO

20

Do you use any adaptive or mobility devices?* This field is required.

YESNO

21

What do you hope a Service Dog can do for you?* This field is required.

22

What task or work do you want a Service Dog to perform?* This field is required.

23

Do you have the financial ability to care for a dog?* This field is required.

YESNO

24

Since caring for a dog requires financial resources for food, healthcare, and maintenance, we are unable to proceed with the program at this time. If your circumstances change and you're able to provide the necessary care, please feel free to reach out to us in the future.

25

How much do you expect to spend a year on dog care & maintenance?* This field is required.

26

What is your source of funding?* This field is required.

27

Who lives in your household?* This field is required.

28

Have you discussed getting and training a Service Dog with household members & caretakers?* This field is required.

YESNO

29

Are they on board & willing to sign off on a Service Dog?* This field is required.

YESNO

30

What other animals live in the house? What are their ages, sex, reproductive status (spayed/neutered), vaccination status, & have they had any training (if applicable)* This field is required.

31

What other animals live on the property?* This field is required.

32

Do you work, go to school, or volunteer outside of your home?* This field is required.

YESNO

33

If yes, is this full or part time?* This field is required.

Full Time

Part Time

34

Describe your activities at work, school or in your volunteer hours?* This field is required.

35

Are there hazards that would affect handling a service dog in your school or work?* This field is required.

YESNO

36

Where would your Service Dog be able to eliminate?* This field is required.

37

Where is a safe spot for your Service Dog to rest while you are there?* This field is required.

38

Have you discussed handling a Service Dog with your employer or school administration?* This field is required.

YESNO

39

Will they sign off on it?* This field is required.

YESNO

40

How many medical appointments do you have per month?* This field is required.

41

How many hospitalizations in the past year, or how many are typical in a year?* This field is required.

42

How many of the hospitalizations were longer than 48 hrs.?* This field is required.

43

Does your landlord, HOA, homeowners’ insurance or local ordinance restrict the size or breed of a dog you can have?* This field is required.* A dog is not exempt from this until it has graduated from Service Dog training*

YESNO

44

What breed(s) of dog would you like to be your Service Dog?* This field is required.

45

Where do you plan to acquire a dog?* This field is required.

46

Have you begun the process of selecting a dog, such as talking with breeders or shelters?* This field is required.

YESNO

47

Do you already own a dog that you hope to become your Service Dog? * This field is required.

YESNO

48

Why did you pick this dog or why do you think your dog would be a good Service Dog?* This field is required.

49

Training a Service Dog typically costs $10,000 or more over a period of 12-24 months to fully complete. However, many dogs are dismissed after 18 months of training, often after a significant portion of the expenses have already been incurred. Is this an acceptable financial risk for your situation?* This field is required.

YESNO

50

We are unable to assist you at this time.

Training a service dog requires a significant financial commitment, and due to the high rate of attrition—where many dogs do not successfully complete training despite extensive time and resources invested—we must ensure our funding is used effectively. Unfortunately, if this financial risk is not acceptable for your situation, we are unable to move forward with assistance. However, if your circumstances change, please feel free to contact us to explore potential opportunities.

51

Over half of Service Dog prospects do not successfully complete training. If your dog is not successful, will you choose to keep or rehome them?* This field is required.

Keep

Rehome

52

If you plan to rehome, who will be adopting your dog?* This field is required.

53

I understand the risks and commitments of the VetPets of SWPA Service Dog Prospect Program. I understand the submission of this application is not an automatic acceptance into the program.* This field is required.

Clear