CSDA Recruit Raiser Application

Personal Information

First Name

Last Name

Address Line 1

Address Line 2

City

Country

State

Postal Code

Phone

Preferred form of communication

TextEmailPhone

Age

Date of Birth

Are you, the applicant, 18 years of age or older?

YesNo

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?

Criminal Background Check

California Service Dog Academy conducts background checks on applicants through a third party organization. California Service Dog Academy does not accept applications from individuals with a history of violence against animals or people, including sexually violent crimes or arson. Separate Authorization and Disclosure forms will be sent regarding this background check. If you do not agree to receive information regarding a background check, CSDA may not be able to move forward with processing your application.

Do you agree to receive information regarding a background check including the Disclosure and Authorization forms from CSDA?

YesNo

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