CSDA Recruit Raiser Application
Personal Information
First Name
MI
Last Name
Address Line 1
Address Line 2
City
Country
Please select...
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos ( Keeling ) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Côte d ' Ivoire
Croatia ( Hrvatska )
Cuba
Cyprus
Czech Republic
Congo ( DRC )
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands ( Islas Malvinas )
Faroe Islands
Fiji Islands
Finland
France
French Guiana
French Polynesia
French Southern and Antarctic Lands
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Honduras
Hong Kong SAR
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao SAR
Macedonia, Former Yugoslav Republic of
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russia
Rwanda
Samoa
San Marino
São Tomé and Prìncipe
Saudi Arabia
Senegal
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
Spain
Sri Lanka
St. Helena
St. Kitts and Nevis
St. Lucia
St. Pierre and Miquelon
St. Vincent and the Grenadines
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Viet Nam
Virgin Islands ( British )
Virgin Islands
Wallis and Futuna
Yemen
Zambia
Zimbabwe
State
Please select...
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
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District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
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Mississippi
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New Hampshire
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New York
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Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
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Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Puerto Rico
Virgin Island
Northern Mariana Islands
Guam
American Samoa
Palau
Postal Code
Phone
Email
Preferred form of communication
Text
Email
Phone
Age
Date of Birth
Are you, the applicant, 18 years of age or older?
Yes
No
If you are a minor, who is the adult that will oversee the process and provide support as needed? (Include guardian's full legal name)
Guardian's Email
Guardian's Phone
Who will be primarily responsible for care and training of the recruit?
Household Information
Do you rent or own your home?
Rent
Own
If you rent your home, do you have permission from your landlord to have a dog? (If owned select "does not apply")
Yes
No
Is your yard fenced?
Yes
No
Do not have a yard
Please describe your home and yard.
Please list all
HUMAN
members in the household.
If any children please list their ages
.
Are all members of the household interested in becoming a recruit raiser, and willing to comply with our procedures?
Yes
No
Are any members of the household allergic or scared of dogs?
Allergic
Scared
Neither
Both
Have you ever had a puppy/dog before?
I have raised a puppy before
I have only had older dogs
I have never had a dog before
Do you have any dogs?
Yes
No
Is your dog(s) spayed/neutered?
Dog(s) is intact
Dog(s) is spayed/neutered
Female ONLY is intact
Male ONLY is intact
Does your dog(s) get along well with other dogs?
Yes
No
Depends
Please list all
ANIMAL
members in the household.
Please list species. For dogs please list age, and gender.
Please describe a typical day in your household:
Please describe what a typical day will look like for a recruit in your household:
Program and Policy
Do you have a preference on a puppy or older dog (2years)?
Puppy
Older
Either
Realistically, when is the soonest you can take on one of our recruits?
Puppies, as well as older dogs need socialization. How many times per week can you reasonably take your puppy/dog out for field trips?
1-3x per week
3-5x per week
5x or more per week
Training is an important aspect of raising a service dog. Are you willing to commit to at least 1hr of training with your puppy/dog everyday?
Yes
No
Are you willing to commit to at least 2 monthly meetings with one of our trainers? (With the recent pandemic we understand some people would prefer to social distance. CSDA will accommodate virtual sessions, as well as take precautions in person with masks, gloves, at least 6ft distance apart, and regular sanitization).
Yes
No
Yes, but due to COVID-19 I am only comfortable with virtual sessions for now.
Are you aware that puppies pee, poop, jump, bite, chew stuff, get up early, require frequent potty breaks, bark, whine, cry, require training, go to the vet a lot and are all kinds of wonderful if you can be patient and enjoy this puppy phase?
Yes
No
Are you willing to commit to using positive reinforcement training techniques with your recruit?
Yes
No
Are you willing to accept our Foster Swap policy? (Every 3 months all puppies will be swapped between fosters to help with their training and help them be able to acclimate to new environments and situations)
Yes
No
Why do you want to be a Recruit Raiser?
How did you hear about us?
TYPED SIGNATURE
: I have read the following documents and agree to abide by all terms and conditions outlined (By typing your name below you agree).
Contact Information