4 Paws 2 Freedom 2023.2 Online Service Dog Application 
Application for Service Dog Training Program
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 4 Paws 2 Freedom considers all applications regardless of race, sex or religion.
Name (first and last) *
Street Address *
City *
State
 *
Zip
 *
Phone
 *
Email Address
 *
Are you a Veteran?
 *
Are You Active Military?
(For Veterans Only)
Are You a Combat Veteran?
(For Veterans Only)
How long did you serve?
(For Veterans Only)
Where did you serve?
(For Veterans Only)
When were you discharged?
(For Veterans Only)
ΜΜ
/
ΗΗ
/
ΕΕΕΕ
What Branch?
(For Veterans Only)
How Long have you been back in the United States?
(For Veterans Only)
Are you a student in a college or university?
 *
If yes, what college or university and where are you attending classes?
Are you a Firefighter?
 *
Are you in Law Enforcement?
 *
Are you a Dispatcher?
 *
Your Date of Birth
 *
ΜΜ
/
ΗΗ
/
ΕΕΕΕ
Where did you hear about 4 Paws 2 Freedom?
 *
Have you ever been convicted of a felony?
 *
If yes, please explain
Emergency Contact Name
 *
Relationship
 *
Phone
 *
Your Occupation
(Complete this if you work or volunteer)
 *
Your Employer
Number of hours worked per week
Is your employer aware and ready to make a reasonable accommodation for you and your service dog? 
Describe how your disability impacts you
 *
Are you physically able to train your own dog? 
Training requires a lot of  bending, stooping, reaching, kneeling, standing, walking, sitting as well as other strenuous activity.  
*
Do you have a Primary Care Physician? How do they feel about you having a service dog?  *
Are you currently in therapy with a licensed mental care provider? How do they feel about you having a service dog?  *
Do you have a dog now who you wish to train to be your service dog? *
Name of Dog
If Yes, please answer this and the following questions
Breed
age
Spayed or Neutered?
How long have you had your dog?
How old was he/she when you got him/her?
Name of your Veterinarian
Phone number of your veterinarian
How does your dog react to dogs he/she does not know?
How does your dog behave around cats?
Does your dog enjoy being around children?
Have you ever heard your dog growl at a person?
Has your dog ever bitten anyone?
Has your dog ever been injured by another dog?
Does your dog frighten easily, or is he/she jumpy?  Please describe.
What pets do you have at home? *
Is there other information you would like us to know for processing your application? *
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