Early Alert Canines Preliminary Application
Early Alert Canines (EAC) provides both full-access Service Dogs and Skilled Companion Alert Dogs to residents of California, Oregon, Washington, and Nevada. Before  applying, please be sure to review our Frequently Asked Questions.

Due to the number of application requests received, your application may take up to 12 business days to review. If approved, you will receive an email explaining next steps. Please note, you will be added to EAC's email newsletter to help keep you informed of what's happening at EAC, program updates, and policy changes. You may unsubscribe at any time. 
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Applicant's Full Name: *
Name of parent/guardian if applicant is under the age of 18:
Date of Birth: *
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Email: *
Phone Number:
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Address: *
City *
State *
Zipcode *
Type of service dog you are applying for: *
When was the applicant diagnosed with insulin-dependent diabetes? *
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Have you reviewed the Frequently Asked Questions page on Early Alert Canine's website? *
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Please describe how diabetes affects your life: *
What is your expectation of a partnership with a diabetic alert dog? *
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