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ANIMAL FARM FOUNDATION ASSISTANCE DOG PRE-APPLICATION

If you are disabled and interested in one of our assistance dogs, please complete this pre-application.  There is no charge to the client for one of our dogs or for support training. Completing this application is not a guarantee that you will recieve a dog.  The dogs and clients will be matched based on dog capabilities and client needs.   

Please provide the requested information and answer the included questions. 

All fields with an * are required.  Thank you.

 
Name*
 
 
Address*
 
 
Phone:*
 
 
Email Address:*
 
 
Applicant's Date of Birth*
 
 
Employer
 
 
Occupation
 
 
Height*
 
Weight*
 
Please describe the ways in which a service dog will enhance your abilities. *
 
 
Please describe all the animals (pets and livestock) that are part of your household.*
 
 
What type of home do you live in?*




 
 
Is your yard fenced?*

 
 
Please describe the other members of your household. Do you have an attendant?*
 
 
Please describe any experience you have with training dogs. *
 
 
Have you ever partnered with a service dog? Please give details.*
 
 
Have you applied with other service dog programs? If so, how long ago?*
 
 
Do you use special equipment or assistive technology (i.e., cane, wheelchair, van with lift, walker, braces, speechboard, other devices). If yes, please explain.*
 
 
How do you get around town? (i.e. van, own car, public transportation, friends) please describe.*
 
 
Describe your home life, social activities, hobbies and lifestyle in general. Do you work or travel or go to school or volunteer?*
 
 
Please describe your typical day.*
 
 
Why do you want a dog from the Animal Farm Foundation Assistance Dog Training Program?*
 
 
To prevent spam, please answer the following question.
What is the sum of five and nine?*
 
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