Career Change Application – Service Dogs for America

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

Your Age *

Under 20
20-35
35-50
50-60
60+

Employer *

Job Title *

Please describe your typical work day (i.e., time you get up, go to work, get home, etc.): *

Please enter information on all other members of the household. (Name, Relationship to Applicant, Age, Disability Status) *

Name, Relationship to Applicant, Age, Disability Status

Type of Home: *

Apartment
Condo
Mobile Home
Twin Home
Single Family Home
Other

How many levels does your home have? *

Approximate square footage of home: *

Where is your home located? *

City
Suburbs
Rural

Do you have a securely fenced yard? *

Approximate square footage of yard: *

Where exactly would the dog sleep? *

How many hours a day on average will the dog be left alone? *

When left alone, where will the dog be? *

Inside
Outside

Do you own or rent your home? *

Own
Rent

Do you have the landlord's permission to have a dog in the home? *

Please provide landlord's name and phone: *

Do you have any other animals in your home? *

Please describe all animals currently in your home: *

Breed/Type, Age, Sex, Spayed/Neutered?, Temperament, How Long in Your Family

Name of Current Veterinarian (or veterinarian you intend to use if you do not currently have one): *

Veterinarian Address Information *

Address Line 1

Address Line 2

City

State

Zip Code

Veterinarian Phone *

Do you have previous experience with dogs? *

Please explain your dog experience: *

Why do you want a career change dog? *

Is there anything else you would like us to know about you?

Reference Name *

First

Last

Please provide a reference who does not reside with you.

Reference Phone *

Second Reference Name *

First

Last

Please provide a second reference who does not reside with you.

Second Reference Phone *

Required Acknowledgments *

I understand and agree that a career change dog cannot be used or listed as a working service dog under any circumstances.

I understand that submitting an application does not guarantee an adoption.

I understand that only complete applications will be considered.