APPLICATION – Service Dogs for America

Pre-App Guidelines Acknowledgments *

I have read and understand the policies and procedures set in SDA's Pre-App Guidelines.

I understand the types of service dogs trained by SDA and acknowledge that SDA does not train dogs for individuals with multiple complex mental health issues or autism.

I understand and acknowledge the entire application procedure, and understand I will have to aid SDA in gathering required information.

I understand and acknowledge the notification, travel, and training procedure requirements of SDA.

I understand and acknowledge the team sponsor requirements.

I understand and acknowledge the placement interruption procedure.

I understand and acknowledge the post-placement procedure required by SDA.

I understand that SDA reserves the right to stop the application, training, and/or placement process at any time.

Applicant Information

Title

Applicant Name *

First

Middle

Last

Name of Parent or Guardian (if applicable):

First

Last

Applicant Age *

Applicant Gender *

Applicant Date of Birth *

Applicant Height *

Applicant Weight *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

Occupation *

Work Phone

Have you ever served in the US Military? *

Branch of Military Service *

Date of Discharge *

Nature of Discharge *

Have you ever been charged, arrested, or convicted of any offense or crime? *

Please explain: *

Disability Information

Description of Disability(ies) *

Include specific information regarding your diagnosis(es), prognosis, and limitations. List all secondary physical and/or psychological diagnosis(es).

Attach/Upload any additional disability information you would like to provide here.

Click or drag files to this area to upload. You can upload up to 3 files.

What type of service dog would meet your needs? (Please check all that apply) *

Seizure Response [Emergency Medical Response Service Dog]
Diabetic Alert (Type 1 Diabetes Only) [Emergency Medical Response Service Dog]
Post-Traumatic Stress Disorder (PTSD Only) [PTSD Service Dog] (To apply for a PTSD Service dog you must have an official PTSD diagnosis, be over 21 years old, AND be actively engaged in mental health therapy for PTSD for one (1) year minimum)
Mobility Assistance Dog
Facility Dog (Facilities, Organizations, Businesses Only)
Courthouse Dog (Courthouse Dog Programs Only) Application of interest only. Courthouse Dog Program coming soon!

List the specific tasks you need a service dog to perform to mitigate your disability(ies). *

Describe the facility needs and tasks required of dog. (Facility/Courthouse Applicants) *

List all organizations you have applied to for a service dog and approximate dates applied. *

May we contact the organizations listed *

Please explain why not: *

Dog Care

Do you have time to spend with the dog daily? *

Are you able to exercise the dog multiple times per day? *

Are you able to toilet and clean up after the dog, multiple times per day? *

Are you able to groom the dog? *

Are you able to take the dog to the veterinarian? *

Will you service dog accompany you to school/work? *

Will you service dog accompany you on vacations? *

How many hours a day will your service dog be alone? *

Please explain why your service dog would have to be alone: *

Required Acknowledgments *

If approved to receive a service dog from Service Dogs for America (SDA), I will be required to travel to SDA's campus in Jud, ND for three weeks (minimum) of training, at my own expense.

If approved to receive a service dog from SDA, I understand the cost of a service dog from SDA is $25,000. There are sometimes grant and fundraising opportunities available for qualified and approved applicants. Available grants are awarded on a first come, first serve basis.

I understand I must have a medical disability based on documents diagnosis/es (from a qualified and licensed medical and/or mental health professional) that warrants placement of a service dog.

If applying for a PTSD service dog, I must have a PTSD diagnosis (from a qualified and licensed mental health professional), be over 21 years old, and be actively engaged in therapy for a minimum of one year for my PTSD.

I understand the estimated yearly cost of caring for a service dog is roughly $2,500 and I understand I am responsibly for (and can afford) these expenses.

If approved for a service dog from SDA, I understand I will be subject to a criminal background check and home visit prior to a service dog placement.

I have read and fully understand the SDA procedure of application (including eligibility requirements and disclaimers), as described in the Pre-App Guidelines document.

I understand only complete preliminary applications will be considered.

I understand applying for a service dog from SDA does not guarantee I will receive a service dog from this organization.

Preliminary Application

Applicant Information

Disability Information

Dog Care