Contact Details
Legal First Name
Last Name
Preferred Name
Email
Address Line 1
City
State
Please select...
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
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Louisiana
Maine
Maryland
Massachusetts
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Montana
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Nevada
New Hampshire
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Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Puerto Rico
Virgin Island
Northern Mariana Islands
Guam
American Samoa
Palau
Postal Code
County
Date of Birth (MM/DD/YYYY)
Gender
Male
Female
Other
Please select one of the following: Military (If you have ever or are currently serving in the Military), or Non-Military
Please select...
Military
Non-Military
Please select all of the following that
currently
apply to you:
Please select...
Active Duty
National Guard
Foreign (Non-US) Service Member/Veteran
Reserve
Veteran
Please select all of the following that
currently
apply to you:
Please select...
Caregiver
Family Member
First Responder
Government Employee
Areas of Interest
CPV Headquarters (Chittenango, NY)
Southern Tier Region (Broome County, NY)
Hudson Valley Region (Wappingers Falls, NY)
Western New York Region (Rochester, NY)
Home Phone
Mobile Phone
Are you interested in applying to become a Puppy Ambassador?
A Puppy Ambassador is a volunteer who helps with daily tasks such as training, playtime and socialization for puppies while they are on Clear Path property.
Yes
No
1.
Do you have other animals in your household? If so, please list the species, breed, and age of all animals currently in the household.
2.
How many adults and children are currently residing within your household (including self)? Please list the age of each.
3.
What is the square footage of your home or place of residence? Is there a fenced in yard? Are there stairwells? This information is helpful for our staff to track each puppies exposures during their training.
4.
Do you live in a high vehicle trafficked area? If so, please describe.
5.
Do you have a quiet area for the puppy to retire/rest? If so, please describe.
6. Are you considering Clear Path's long-term puppy raising program?
7.
Please provide the average time you're able to commit to your ambassadorship. Please discuss your typical availability.
8.
Please describe any experience of you have in raising puppies and/or dog training.
9.
Are you interested in field trips? Field trips are scheduled outings with the purpose of exposing the puppy to new environments/stimuli.
Yes
No
10.
Are you willing to participate in a group training class with a selected puppy?
Yes
No
11.
Are you comfortable with participating in regular training sessions both at Clear Path and in public locations?
Yes
No
12. Are you able to commit to training classes, 1 hour per week, during our working hours of 9:00am-4:30pm Monday through Friday?
Yes
No
Are you interested in applying to become a Canine Guardian?
A Canine Guardian is a volunteer who fosters, raises and trains a service dog from 9 weeks to 18 months.
Yes
No
Foster Period.
Long Term (6+ Months)
Short Term (3-6 Months)
Flex-foster (Short Term Support)
1. Are you currently employed? If so, what is your current work schedule?
2. Do you have other animals in your household? If so, please list the species, breed, and age of all animals currently in the household.
3. How many adults and children are currently residing within your household (Including Self)? Please list the age of each.
4. What is the square footage of your home or place of residence? Is there a fenced in yard? Are there stairwells?
5. Do you live in a high vehicle trafficked area?
6. Do you have a quiet area for a dog to retire to? If so, please describe.
7. Why would you like to participate in Clear Path's Canine Guardian Program?
8. Do you require any additional support outside of our standard procedures for this program?
9. Who will be the primary caretaker and handler for the dog?
10. Please describe any experience you have in puppy raising/dog training.
11. How do you correct unwanted behavior with your dogs, or dogs you've had in the past?
12. Are you willing to take your dog to work with you if employed? If so, please describe the type of work environment.
13. Please describe any situations where the dog would have to be left home without supervision and for how long that period of time may be.
14. What dog training courses have you completed?
15.
Do you have any mobility/health concerns that could affect your training with the puppy?
16. Are you able to participate in pick up/drop off and training sessions for the duration of your foster period? If not, please explain.
17. Are you able to commit to training classes, 1 hour per week, during our working hours of 9:00am-4:30pm Monday through Friday?
Yes
No
18. Would you be willing to commit to training sessions on a more frequent basis if necessary?
Yes
No
19.
Are you willing to utilize a dog crate?
Yes
No
20. Are you comfortable with a Canine Program representative conducting a home visit?
Yes
No
Are you a practitioner interested in volunteering in our wellness program?
Yes
No
Modality
Acupuncture
Marma
Massage or Reflexology
Meditation
Polarity
Reiki or Quantum Touch
Yoga
Qigong
Other
Date of License/Certification
Date of License Expiration
License Certification by
Date of License / Certification 2
Date of License Expiration 2
License Certification by 2
If your license / certification requires insurance, please indicate effective date
I can commit to
1 Day Per Month
2 Days Per Month
3 or More Days Per Month
Other
Days of the Week I Prefer to Volunteer
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Please list three references with contact information
Reference #1
Reference #2
Reference #3
What is your experience with military, or warrior culture?
Comments
Are you applying for an Internship at Clearpath?
Yes
No
School/Program Advisor Information
School Name
Advisor First Name
Advisor Last Name
Advisor Phone
Advisor Email
Are you volunteering with a group?
Yes
No
Organization or Group:
How did you hear about Clear Path?
Please share any special skills, interests and anything else you would like to tell us about yourself.
Emergency Contact Information
First Name
Relationshi
p
Please select...
Friend
Parent / Guardian
Relative
Spouse
Phone
Last Name
By clicking Accept below, you acknowledge that you have carefully read and accept the terms and conditions of the Clear Path for Veterans Volunteer Waiver, which includes our current COVID-19 guidelines. To see the full text of the volunteer waiver,
click here
Accept Terms and Conditions
Contact Information