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United States of America 501(c)(3) / 88-2527292
A NonProfit Organization
VETERANS CRISIS LINE ; DIAL 988, PRESS 1
Service Dog Application
First name
Last name
Email
State and County of Residence
Phone
How did you find out about us?
Select an option
Which days are you available?
Mon
Tue
Wed
Thu
Fri
Sat
Tell us about yourself and your need for a service dogs.
Have you previously worked ith a Service Dog?
Have you previously or currently owned /own a pet ?
Please check one
Veteran
Active Duty
First Responder
Gold Star
Student
Family Member/Spouse (of any of the above)
Civilian
Branch of Service
Air Force
Army
Marine
Navy
U.S. Coast Guard
National Guard
Police
Paramedic/EMT
Fire and Rescue
Tell us what you hope a service dog can do for you?
Do you have a DD214?
Yes
No
What area of training will you require?
Diabetic Alert/Response
PTSD
TBI
Autism Assistance Dog
Mobility Assistance
Cardiac (POTS,Long QT etc)
Seizure Alert/Response
Hearing
Stroke Alert/Response
Allergen Detection
Migraine Alert
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