Preliminary Application

*We, like much of the country, are experiencing staffing shortages. Due to these shortages, we are experiencing a delay in processing preliminary and full applications.
We are working diligently to remedy the situation and apologize for the unexpected delays. Thank you, in advance, for your patience.*

Review Procedure for Application

- Step 1 of 6

Title

Applicant First Name *

Applicant Middle Name

Applicant Last Name *

Service Dogs for America (SDA) Procedure for Application Acknowledgments

Please read SDA's Procedure for Application document above to understand the organization and its requirements.

I have read and understand the policies and procedures set in SDA's Procedure for Application document. *

I understand the types of service dogs trained by SDA and acknowledge that SDA is not accredited for/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, including the understanding that SDA only places dogs in the lower 48 United States. *

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

I am applying for a service dog for: *

Myself (Under 18 years old)
Myself (Over 18 years old)
Another person (Under 18 years old)
Another person (Over 18 years old)

Name of Parent or Guardian *

First

Last

Parent or Guardian Phone *

Parent or Guardian will be contacted for approval on all applications for individuals under 18 years old.

Relationship to Applicant *

When applying for another person, please list your relationship to the applicant.

Applicant is a legal, permanent resident of the United States of America. *

Applicant Date of Birth *

Applicant Age *

Applicant Gender *

Applicant Height (feet) *

Applicant Height (inches) *

Applicant Weight (pounds) *

Current Address

*To ensure HIPAA compliance, communication about your application will come via USPS mail. Please ensure your address is correct*

Street Line 1 *

Street Line 2

City *

State *

Zip Code *

How long have you lived at this current address? *

0 - 6 months
6 - 12 months
12+ months

Previous Address

If you have lived at your current address for less than 12 months, please provide your previous address below.

Street Line 1 *

Street Line 2

City *

State *

Zip Code *

How long did you live at this previous address? *

0 - 6 months
6 - 12 months
12+ months

Do you plan to move in the next 6 months? *

Please explain the reason for your upcoming move. *

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, including the state in which the infraction(s) occurred, date(s), charge(s), and imposed sanction(s): *

Complete information is required for consideration.

Disability Information

List of Disability(ies) - Include all of your physical and psychological diagnosis(es), prognosis(es), and limitations (do not use abbreviations). Applications that do not include a complete diagnostic statement will be denied. *

Upload a full diagnostic statement from a health care provider that includes medical documentation of your disability(ies). *

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

This can be obtained from your health care provider(s) or via your online health chart(s) from your provider. All diagnoses (physical, neurological, and/or psychological) must be included. Applications will not be processed without this official documentation.

Upload your DD214 or similiar document here. *

Click or drag files to this area to upload. You can upload up to 2 files.

Service Dog Information

Are you applying to have your own current PERSONAL dog trained by SDA as a service dog? *

Due to accreditation, SDA does NOT train personal dogs. SDA is only accredited to provide service dogs from our own kennel/inventory. *

I acknowledge that SDA does NOT train personal dogs.

Do you want to proceed with this application acknowledging that you are applying for a service dog from SDA's kennel/inventory, NOT for your current personal dog to be trained by SDA? *

I am applying for a(n): *

Service dog for myself/applicant
Assistance dog for a facility/courthouse

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

Seizure Response
Post-Traumatic Stress Disorder
Mobility Assistance

Name of Facility: *

Type of Facility: *

School
Assisted Living/Nursing Home
Group Home
Courthouse
Other (describe in question below)

Tasks Needed: A service dog is a medical necessity just like a pace maker or insulin pump. List at least 5 tasks you would like a service dog to perform for your disability. Tasks must be medical tasks – never protection or guarding. Applications that do not include tasks specific to disability(ies) will be denied. *

Task 1

Task 2

Task 3

Task 4

Task 5

Please explain why you feel you are a good candidate for a service dog. How would having a service dog impact your life? *

Please be as specific as possible.

Describe the facility needs and tasks required of the dog. *

Please be as specific as possible.

Have you applied to other service dog organizations? *

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 your service dog accompany you to school/work? *

Will your 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

Your answers indicate that you want your own PERSONAL dog trained as a service dog. SDA is NOT accredited to train personal dogs as service dogs. *

I acknowledge that no further communication will occur in regards to this application as I have indicated that I want my personal dog trained, a service NOT provided by SDA.

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 documented 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. *

No
Yes
Not applicable

I understand the estimated yearly cost of caring for a service dog is roughly $2,500 and I understand that I am responsible 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 consent to a criminal background check. *

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. *

I understand that SDA is currently experiencing staffing shortages and there may be delays in application processing times. *

Please type your full name in the box below to attest to the following statement: I attest that the above answers and statements are true and factual to the best of my knowledge. *

All applicants will be considered regardless of ethnicity, gender, religion, creed, or sexual orientation.

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