NEADS  NEADS Service Dog for a Child with Autism Application 

| 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.

Please be prepared to spend some time on this application. You will have the ability to save your application if you are unable to finish it in a single sitting. The details you provide will help us in this initial step in the process.
Applicant Information
Please provide the following information about your child:





Parent/Guardian Information
NEADS accepts applications from a child's parent(s) or legal guardian.

Name of person completing the application:













NEADS dogs are typically Labrador retrievers. Please visit www.assistancedogsinternational.org (ADI) to help you find an organization that can meet your needs. 




Thank you for your interest, but we are unable to continue with the application process. Please visit www.assistancedogsinternational.org (ADI) to help you find an organization that can meet your needs. 

Please note that if you are more than a 3-hour drive from campus, we can begin the process with a Skype interview, but a final decision cannot be made until the child is seen on campus.
Thank you for your interest, but we are unable to continue with the application process. Please visit www.assistancedogsinternational.org (ADI) to help you find an organization that can meet your needs. 
Physician & Emergency Contact Information
Your Child's Physician Information
Please note: If you are invited to interview for our program, we will provide you with a medical report that needs to be completed by your child's primary care physician.






Emergency Contact Information
Not including yourself, who can we contact in the event of an emergency?






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






When describing your child's medical history, please do not use abbreviations or initials for diagnoses or conditions that are atypical or rare. Commonly used abbreviations such as ASD and ADHD are fine.

Thank you for your interest, but we are unable to continue with the application process. Please visit www.assistancedogsinternational.org (ADI) to help you find an organization that can meet your needs. 
We understand that communication challenges and restricted and repetitive behaviors vary greatly across the autism spectrum and other developmental disabilities. The same is true for our clients. There is no right or wrong answer to these questions; we just want to have a very clear picture of your child so we can start to evaluate if we are the right program.













How will a Service Dog help your child?
All dogs are taught basic dog obedience and socialized in public situations. 
Please indicate which tasks you think would help your child:
(The Service Dog will rest his head on the child's lap. This can calm or interrupt an unwanted behavior.)
(The Service Dog can flip on a light switch, lessening a child's fear of the dark.)
(The Service Dog will put its front two paws onto the child's legs, while the child is seated in a chair or on the floor. The deep pressure can help with sensory integration.)
(The child can use this task to communicate with a parent. Because the Service Dog barks on command, the parent knows that when the dog barks, the child needs assistance.)




If you share custody, the support of the other parent and a description of their living situation will be assessed during the evaluation process.























Other members of the household


Please note: NEADS will require a letter from all adults in your immediate household stating that they are aware that a Service Dog may be placed with the applicant and understand the implications for the household. NEADS will provide details about what's required during the application review process.




Home environment



Apartment Details





Yard details




Rental details
If you are renting, please fill details below.



If your child is accepted to the NEADS program, we will need to have written permission for you to have a Service Dog in your home.
Child's Schooling/Education



School details







Thank you for your interest, but we are unable to continue with the application process. Please visit www.assistancedogsinternational.org (ADI) to help you find an organization that can meet your needs. 





Family Lifestyle





Current Dog and Other Pet Information



Dog Ownership History






Caring for your Future Service Dog
NEADS clients are responsible for providing appropriate care and exercise and a healthy, safe environment for their Service Dog. Please answer the following questions to help us understand the environment you will provide for your Service Dog should your child be accepted into the NEADS program.





Service Dog Training
All clients are trained with their dogs at the NEADS campus in Princeton, MA.

We're sorry, but we are unable to proceed with your application. Training at the NEADS campus is integral to the success of our Service Dog teams and a required part of our program. You can read more about our client training here.
If accepted for a Service Dog, when the right dog has been selected, we typically provide 4 weeks notice prior to training.

Thank you for your application. Please click SUBMIT to proceed to the final step, which will take you to a signature verification page. You must sign at the bottom of this page and click the 'Submit Signed Response' button to complete your signed response.

You will receive two emails:
The first is an email asking you to verify your signature. You must click on the link in that application to verify and ensure that your application is received.

You will also receive an automatic email confirming our receipt of your application. NEADS staff will review your application and be in touch with you within 8 weeks.

Thank you,

the NEADS Client Services Team