WFSD program is specifically for combat veterans with PTS.

After completing this online Veteran application AND the online background check application you will need to complete and return the following to WFSD:

1. Self Report Assessment - Part 2 will be emailed upon submission of this application.

2. Provider Letter - Letter must include information from the WFSD Medical Reference Form included in Part 2 that will be emailed to you upon submission of this application.

3. A Copy of Your DD214 Form

AFTER ALL OF THE ABOVE ARE RECEIVED WE WILL CONTACT YOU TO SET UP A TIME TO CONDUCT A PHONE INTERVIEW.

Application Type

ALL applicants must be cleared through a background check. Click this link to pay for and apply for a background check:

BACKGROUND CHECK APPLICATION.

Background Check: Did you click link above and complete the online application for the background check?

BACKGROUND CHECK REQUIRED

BACKGROUND CHECKS ARE REQUIRED - CLICK THE LINK BELOW & COMPLETE THE BACKGROUND CHECK APPLICATION TO UNLOCK THE REST OT THE APPLICAITON:

BACKGROUND CHECK APPLICATION.

Background Check: Did you click link above and complete the online application for the background check?

APPLICATION

PERSONAL INFORMATION

First Name

Last Name

Address (Please include City and State)

Time at Address

Alternate Email

Home Phone

Cell Phone Number

Other Phone

Gender

Birthdate: using this format 01/01/1950

Household Number: How many people live in your household?

Household Members: Please give names/age/relationship to you for each member living in your household:

Pets: Pets you currently own: (Specify species, age, breed, etc or None)

Pet Allergies: Any allergies associated with any particular breed? (If yes, specify)

Veterinarian

Veterinarian Address & Phone

Veterinarian Permission: Do we have permission to contact the Veterinarian listed above

VETERINARIAN ASSISTANCE: Will you need assistance obtaining or maintaining veterinarian care?

Veteran Home: Describe your home and neighborhood (house, apartment, mobile home, size of yard,city suburb, country, etc.)

Home

Do you own or rent your home

Landlord's Contact information: Name, Phone, email or NA if you own your home

Landlord Permission: Will you be able to obtain written permission from you Landlord:

Describe your Property

Neighborhood

Water: Do you have a swimming pool, pond, creek or other body of water on or near your property?( please describe) (*Is there a secure fence around the swimming pool? Is there fencing that securely encloses a dog area away from bodies of water?)

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:

MILITARY/WORK HISTORY

Warrior Freedom Service Dogs is a non- profit organization that is dedicated to those that have served in combat. If you have not served in combat and still would like to request a service animal please contact Warrior Freedom Service Dogs, Inc. 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 Warrior Freedom Service Dogs. Decisions of eligibility of service will be determined by the board.

Are you a Veteran

Dates of Service (MM/DD/YY)_______to____

Which war(s) did you serve (Please note, our program is for combat veterans with PTS; therefore, you must have served in combat to qualify)

Military Service: Branch

Rank & Occupation

Rate

Veteran Services

If yes, what were they?

Do you see your therapist regularly?

Are you currently in counseling?

Current employment/ Source of Income

Educational degrees:

Name of school, college, or university

Employer

Employer Contact Information

Full or Part time

Number of hours per week:

Length of Employment

BACKGROUND HISTORY:

The staff of Warrior Freedom Service 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?

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:

Service Dog Denial: Have you ever been denied a service dog by an organization?

Denial Information: Please give the reason you were denied

NON-PERSONAL Reference: Name/Phone/Relation

NON-PERSONAL Reference: Name/Phone/Relation 2

Multipart Application Understanding: I ALSO UNDERSTAND THAT THIS IS ONLY PART ONE OF THE APPLICATION PROCESS AND THAT I MUST PROVIDE FURTER DOCUMENTS TO WFSD ACCORDING TO THE OTHER PARTS OF THE APPLICATION PROCESS. PART 2 WILL BE EMAILED TO YOU UPON SUBMISSION OF THIS APPLICATION.

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 WARRIOR FREEDOM SERVICE 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.

Signature: Please provide an electronic signature by filling in your first, middle, and last name below.

Contact Information