Our Mission
Programs
Open menu
Veteran Program
Advocacy and Speaking Engagements
Canine Programs
Donate
VA Resources
Service Dog Teams
Contact Us
Menu
Our Mission
Programs
Open menu
Veteran Program
Advocacy and Speaking Engagements
Canine Programs
Donate
VA Resources
Service Dog Teams
Contact Us
Donate Today
First Name:
*
Last Name:
Phone Number:
*
Email Address:
*
Street Address
*
City
State
ZIP / Postal Code
Best time to contact you:
*
Morning
Evening
Other
If other, please let us know the best time to contact you.
*
Are there other pets in the household?
*
Yes
No
If yes, please list animal and age:
*
Are there children in the household?
*
Yes
No
If so, please list the ages:
*
What is your current living situation?
*
What type of service are you looking for?
*
What is your primary disability and your combined disability rating from the VA?
*
Have you applied for other service dog programs? If so, please list:
*
Are you looking for mentorship in the process of obtaining a service dog?
*
Please describe how your disability affects your life and your current level of independence:
*
In just a few sentences, what is your ultimate goal with a service dog?
*
Have you had professional dog training before?
*
Yes
No
Was it one-on-one or with a group class?
*
Have you ever been to a Board and Train facility?
*
Yes
No
If so, please list:
*
What were the results of the above listed professional training and/or board and train programs?
*
Describe your relationship with your dog now:
*
Dog Information:
Dog Name:
*
Breed:
*
Age:
*
Date of most recent vaccines:
*
Veterinary Office
*
Phone Number:
*
Street Address:
*
City:
State:
ZIP Code:
Emergency Contact:
*
Phone Number:
*
Is your dog currently taking any medication or under any medical care/supervision?
*
Has your dog ever bitten anyone?
*
Yes
No
Please describe:
*
Is your dog currently licensed in your county of residence?
*
Yes
No
Please describe your dog's current behavior, including any behavioral problems or areas of concern:
*
Submit Application
