Do you have a dog? If so, what is it's name, breed and age? If not, do you need help acquiring a dog? *
Your answer
What is your phone number? *
Your answer
What is your full address? (house/apt #, street, city, state, and zip code) *
Your answer
Are you a Veteran, First Responder, or a Family Member of a Veteran or First Responder? *
Choose
Veteran
First Responder
Family Member of a Veteran
Family Member of a First Responder
When is your birthday? (mm/dd) *
MM
/
DD
/
YYYY
When is your dog's birthday?
MM
/
DD
/
YYYY
Are you a renter? Will you be needing a Housing Letter once your dog is certified? *
If you are a renter, please provide the following information for your Housing Letter: Property Management Company''s Name, Property Manager's Name, Property Manager's Phone Number and Email address.
Your answer
Please answer if you are a Veteran or a qualifying Family Member of a Veteran: What Branch of Service were you enlisted in? *
Choose
Army
Navy
Air Force
Marines
Coast Guard
Please answer if you are a First Responder or a qualifying Family Member: What service did you provide to your community? *
Choose
Police Officer
Firefighter
EMT
Emergency Room
ICU/Cancer Unit/Burn Unit
Other
Select the Class Date, Time, and Year that works for best for you and your daily schedule. *
How did you hear about us? *
Choose
Friend
VA Referral
Advertisement/Flyer
A Veteran Awareness Event/Fundraiser
Psychologist/Psychiatrist
Met one of our P.A.W.S.S. Trainers or Alumni
American Legion
Other
Please email the following documents to jannanewman@pupsnwarriors.org *
Required
A copy of your responses will be emailed to the address you provided.