Application for Puppy Raiser

| Resume a previously saved form
Resume Later

In order to be able to resume this form later, please enter your email and choose a password.

Page 1

Applicant General Information

Contact Information

ALSO, please provide a copy of your lease indicating you are able to have dogs in your rental property. If you have been at your current residence for less than 5 years, please provide previous address and duration of stay at those residences for the past ten years on a separate piece of paper or school information if student over 18 years of age.

Page 2

Employment Information

We will need to contact your supervisor to verify you are able to bring a service dog to work.

Page 3

Lifestyle Information
Please list all persons residing with you, including part time residents.

Enter as MM/YYYY

Enter height as feet and inches. Ex: 3' 8"

Page 4

Current Pets

Pet History
Add all animals (birds, cats, dogs, etc.) you once owned but no longer own, since you turned 18. Use the "Add a previous pet" link in the bottom right of this section to add each pet. 

Page 5

Veterinary References
Please provide Veterinary Contact Information

Page 6

List 2 Personal Reference
One reference must be a non-relative
Reference 1

Valid entry 0 - 99
Valid entry 0 - 11

Reference 2

Valid Entry 0 - 99
Valid Entry 0 -11