Operation Freedom Dogs Application Part One
After completing this online application you will need to complete and return the following to OFD:
(You will receive a link to these forms when you submit Part One of the OFD Application)
Self Report Assessment - Part 2 Below
OFD Medical Reference Form - Part 3 Below OR A letter of Reference From Your Medical Provider - Letter must include information from the OFD Medical Reference Form
A Copy of Your DD214 Form

To be conducted after all of the above are received
Phone Interview
Application Type *
Personal Information
Email Address
Your answer
Cell Phone Number *
Your answer
Other Phone
Your answer
First Name *
Your answer
Last Name *
Your answer
Birthdate *
MM
/
DD
/
YYYY
Gender
Address *
Your answer
Emergency Contact & Relationship *
Your answer
Emergency Contact Phone *
Your answer
Emergency Email Address *
Your answer
Alternative Emergency Contact & Phone *
Your answer
Martial Status *
Children *
Are you a Veteran *
Military HIstory
Operation Freedom Dogs is a non- profit organization that is dedicated to those that have served
in the military. If you are not a veteran and still would like to request a service animal please
contact Operation Freedom Dogs for additional resources and information.

Please note, branch of service, term of service, rank, and disability rating are for informational
purposes only and are not factors used to determine eligibility for services through Operation
Freedom Dogs. Decisions of eligibility of service will be determined by the board.
Military Service: Branch: *
Dates of Service (MM/DD/YY)_______to____ *
Your answer
Which war(s) did you serve *
Your answer
Rank & Occupation *
Your answer
Rate *
Your answer
Comments
Your answer
Work/Education
Educational degrees:
Your answer
Name of school, college, or university
Your answer
Current employment/ Source of Income *
Occupation
Current Occupation
Your answer
Full or Part time
Number of hours per week:
Your answer
Employer
Your answer
Employer Contact Information
Your answer
Years in Work
Number of years in current place of work
Your answer
History
The staff of Operation Freedom Dogs understands that these questions are often sensitive areas
to discuss, especially with unfamiliar people. However we are very welcoming to discussion to
clarify any issues you might have in this category. Your answers will not disqualify you from
acceptance
Felony *
Have you ever been convicted of a Felony?
Violent Crime *
Have you ever been convicted of a violent crime?
Substance Abuse Treatment *
Are you currently or have you ever received treatment for substance abuse?
Are you currently in counseling? *
Do you see your therapist regularly? *
ALL applicants must be cleared through a background check. Click this link to pay for and apply for a background check: .
http://bit.ly/OFD_Background_Check
BACKGROUND CHECKS ARE REQUIRED FOR ALL APPLICANTS.
Background Check *
Did you complete the application for the background check by clicking the link above?
Home Environment
Household Number *
How many people live in your household?
Your answer
Household members
Please give names/age/relationship to you for each member living in your household:
Your answer
Pets *
Pets you currently own: (Specify species, age, breed, etc)
Your answer
Pet Allergies *
Any allergies associated with any particular breed? (If yes, specify)
Your answer
Fenced Back Yard *
Fence Type *
If fenced back yard, please describe the fence. *If possible please provide a picture of your fenced yard by mail or email attachment. If No fenced yard, please explain a location for dog to exercise:
Your answer
Veterinarian *
Your answer
Veterinarian Address *
Your answer
Veterinarian Phone Number *
Your answer
Veterinarian Permission *
Do we have permission to contact the Veterinarian listed above
Veterinarian Assistance *
Will you need assistance obtaining or maintaining veterinarian care?
Do you own or rent your home *
Veteran Home *
Describe your home and neighborhood (house, apartment, mobile home, size of yard,city suburb, country, etc.)
Your answer
Dog Approval *
Does your landlord/homeowner association allow dogs and / or have restrictions on specific breeds?
Your answer
Landlord
If renting/leasing, please provide owner/landlord name, address and phone
Your answer
Landlord Permission
Will you be able to obtain written permission from you Landlord:
Other
Service Dog Applicant *
Have you applied for a service dog from a private organization? *Not including the V.A
Service Dog Org
If yes, please provide the name of the organization, contact information and date of application:
Your answer
Service Dog Denial *
Have you ever been denied a service dog by an organization?
Denial Information
Denial Information. If yes, please provide name of the organization, contact information, date of denial and reason given
Your answer
Veteran Services *
Have you received services from organizations that provide service to veterans?
If yes, what were they?
Your answer
AUTHORIZATION TO CONFIRM INFORMATION I CERTIFY THAT ALL INFORMATION PROVIDED IN THIS APPLICATION IS TRUE AND COMPLETE, AND I UNDERSTAND THAT ANY MISSTATEMENT, FALSIFICATION, OR OMISSION OF INFORMATION IS GROUNDS FOR OPERATION FREEDOM DOGS TO REFUSE SERVICES. I AUTHORIZE ANY OF THE PERSONS OF ORGANIZATIONS OR INDIVIDUALS REFERENCED IN THIS APPLICATION TO GIVE ANY OTHER INFORMATION THEY MIGHT HAVE, PERSONAL OR OTHERWISE, WITH REGARD TO ANY OF THE SUBJECTS COVERED BY THIS APPLICATION. I AUTHORIZE OPERATIONS FREEDOM DOGS TO REQUEST, RECEIVE, AND VERIFY ALL INFORMATION GIVEN ON THIS APPLICATION. I UNDERSTAND THE ABOVE INFORMATION AND AGREE TO THESE CONTENTS.
Authorization to confirm information *
AUTHORIZATION TO CONFIRM INFORMATION
Multipart Application Understanding *
I ALSO UNDERSTAND THAT THIS IS ONLY PART ONE OF THE APPLICATION PROCESS AND THAT I MUST PROVIDE FURTER DOCUMENTS TO OFD ACCORDING TO THE OTHER PARTS OF THE APPLICATION PROCESS.
Signature *
Please provide an electronic signature by filling in your first, middle, and last name below.
Your answer
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