Client Application for Certification

| 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.

We are excited you want to be a part of Atlgraphic of dog on woman's lap doing deep pressure therapyas!

Our goal is to help as many people who would benefit from a service dog as possible. Please be aware that we are, however, currently limited in how many people we can take on as clients. Based on your current needs, as well as our availability for support, you may be put on a waitlist. If that is the case, we will try to help you find external support until things are ready for you to enter our program and become an Atlas client. 


Our network of trainers and team facilitators is constantly growing, and we hope to keep increasing the number of people we can help. 


Please complete this form to request certification for yourself and your dog as an Atlas Assistance Dogs certified handler/dog team. All information you provide is confidential and secured with very limited access to only the Atlas staff directly involved in supporting you as a client. 


The certified team will either be the combination of a client and dog, or a client, handler and dog in the case where a client is not able to be the primary handler for their dog. We also allow for cases where more than one handler, more than one dog, or more than one client is certified as part of a team. Our standard application form covers the case of a single client and dog team or a single client/handler/dog team. Please request an Additional Handler Form and/or Additional Dog Form as applicable from info@atlasdog.org and submit it with your application. Each client wishing to certify should complete this application and process in full. 


Please contact us at info@atlasdog.org if you prefer a version of this application that you can print and fill in offline.

Prior to completing this application, please thoroughly review the following:
user manual icon

 Our Client Program to see if our program is a good fit for you.


icon of checklist

Our Obedience Checklist to see if your dog has the foundation needed to enter our program.


You will need to submit two additional forms as part of your application. You can download them here. You will be able to upload them on the final page of the application.


icon for letter of medical indicationA Letter of Medical Indication from your medical provider attesting to your need and that a dog would help mitigate your symptoms. A sample is included here.


vet icon

 An Atlas Veterinary Health Form attesting to your dog's suitability for service work, including current vaccination and health records.

Application Information

This information should be completed pertaining to the primary person for whom the dog is mitigating a disability (i.e. the Client). If there is a single handler in addition to the client, their information should also be included in this application. If multiple non-client handlers will be certified please request and complete an Additional Handler form for each handler. If multiple dogs are to be certified, please request and complete an Additional Dog Form for each dog. Please submit these documents with your application, as applicable. If the dog will serve multiple clients, each client should complete their own application and provide their own Letter of Medical Indication. Only one copy of the dog’s veterinary and health information is required. 

































Applicant's Military/Veteran Status

Please provide the following information for the primary applicant. This is the individual with a disability that the dog will be assisting. Note: military/veteran status does not affect eligibility for our program. It may impact eligibly for scholarship funds to offset program costs. 


If Yes, complete the following





Upload your documentation(optional)
Veterans, active duty personnel, or their dependents wishing to take advantage of possible related funding sources should include a copy of DD Form 214 or an active duty ID card. This information is not required for the application and in no way impacts your acceptance as a client.

Financial Situation
Atlas does all it can to make our programs affordable and accessible to all who would benefit from a service dog. We recognize for some, an overall program fee of $700 may be more than is affordable. For others, they may be able to afford more which can help us offset cost for others. Need for assistance or ability to provide funds to support others does NOT impact your acceptance as a client






Disability Information
















Handler Information

This information should be completed pertaining to the person who will be primarily handling the dog in public venues. The handler is the person(s) able to complete all training with the dog. It is not necessary to complete this section if the client and the handler are the same person. 





















Client Support and Needs

















Client Lifestyle

Please explain a typical week in your life. Do you work, go to school, have regular hobbies or activities, etc.? Help us understand how much you are at home vs. out in different settings. 

















Information about your dog

Note: If you are requesting certification for a second dog, please request and complete an Additional Dog form for the extra dog. 






















Veterinarian









Dog's Training History












Trainer

If yes Please fill the section











Self-Training
Fill out this section if you have mainly been self-training (or using group training) but not working with a private trainer.





Please Answer for the primary person who will be training for the dog.









What has been your biggest training barrier in training and caring for your dog so far?


Additional background information







Emergency Contact Information



























Additional Comments

Information on the person completing this form














Submitting the Application
Upload your Supporting Documents
As a reminder, these forms can be found on the first page of this application.



All set? Please do a final review of your application and this document. We look forward to receiving your application.


icon of checklistOur Application Readiness Checklist to ensure you and your dog are ready to apply.


We will review the application and other required forms for completeness. If information is missing, we will communicate with you to help resolve the issue. When all information is provided and any issues are resolved, we will set up a time to speak with you via video conference