NEADS  NEADS Service Dog for Hearing Application 

















If you have an occupation, please fill in the details below. 
































Please list your height and weight:








If so, please indicate languages:













Who can we contact in the event of an emergency?









If you are renting, please fill details below.




















Please tell us about your lifestyle.








Please tell us about your history in caring for a dog.









Who will help you with the dog's care if you are sick or cannot get outside?















All clients need to be trained with their dogs at the NEADS Campus. 








All dogs are taught basic dog obedience and socialized in public situations. 
To what sounds do you want your dog to alert you?





















Please review the information provided. You will not be given the opportunity to edit this information once it is submitted. Thank you!