Program Application – Service Paws

Application Request

Do you have a disability or disabilities?

If you answered yes, what disability or disabilities do you have?

First Name

Last Name

Phone Number:

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Have you ever been charged with a felony? If yes, what?

Have you ever been charged with animal abuse? if yes, explain.

Do you need a Service Dog? Under the ADA, a service animal is defined as a dog that has been individually trained to do work or perform tasks for an individual with a disability.”

How much do you feel would be the estimated cost to maintain a service dog per month? Ie Vet care, food, grooming?

Are you able to afford training at $50 per session 4 times per month? If no, why not?

Are you able to commit to two years for training a service dog? ie 4 classes a month, 2 group classes a month and 40 hours of volunteering a year.

Do you currently have a dog that you would like to use as your service dog?

Dog’s age and breed

Does your dog have a bite history? If yes, please explain

List three character references and their phone numbers

Thank you! Someone will get ahold of you shortly to schedule an application and evaluation appointment. This appointment will cost $75.00. Do you have any further questions or comments that you would like to discuss when someone reaches out to you?