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Service Dog Application
First name
Last name
Email
State and County of Residence
Phone
How did you find out about us?
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Which days are you available?
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Required
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 ?
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*
Required
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?
*
Required
Yes
No
What area of training will you require?
*
Required
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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