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Page 1

Puppy Raiser Application Form

We appreciate your interest in raising a puppy to be a future Guide Dog or Service Dog. Please review our requirements before filling out the application. At this time our puppy raising program is limited to Southern California.

The first step to becoming a puppy raiser is to submit the online application. You will be notified via email when your application has been received. Prospective applicants must also attend a puppy raiser meeting, orientation session, and schedule a home check visit with a GDA or TLC representative. Once you have completed each of the steps, and your application has been approved, you will be put on the list for a puppy. The typical wait-time for a puppy is 3-6 weeks, but sometimes happen much sooner!

Applicant Information

First Name

Last Name

Contact Information

Street Address

City

State

ZIP Code

Home Phone

Cell Phone

Work Phone

Email

All GDA puppy raisers participate in monthly, local area group meetings while raising the puppy, as well as weekly puppy classes when the puppy is young. Using the dropdown box below, please choose the group closest to you, and/or that represents the easiest commute given weekday traffic patterns. Group locations are as follows:

How did you hear about Guide Dogs of America and the opportunity to puppy raise

Fellow Puppy Raiser who referred you:

GDA booth event name

Other, please describe

Edit section title

Lead ID

Lead ID Populated?

Puppy Group Location

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Caretaker and Household Questionnaire

Are you (the applicant) under 18?

YesNo

How old are you?

Have you talked with your parent or guardian about your interest in puppy raising?

YesNot Yet

Name and phone number of responsible adult:

Are there other adults in the household?

YesNo

If there are other adults in the household, please enter their names and relationships.

FIRST & LAST NAME (Relationship)

Are there children in the household?

Yes

If there are children in the household, please enter their names and relationships.

FIRST & LAST NAME (Age)

If you have school-age children, please describe your typical after-school activities.

Have you ever raised/fostered a guide dog or other service dog puppy?

YesNo

If you have raised/fostered a guide dog or other service dog puppy, for which organization?

Do you rent or own your residence?

RentOwn

Do you have your landlord’s permission to house a dog in your residence?

YesNot Yet

Do you have a fenced yard?

YesNo

Do you work outside the home?

YesNo

Do you have permission to bring the dog to work?

YesNot Yet

Do you work from home?

YesNo

What do you do for work?

Whether working from home or at an office, how do you anticipate managing a puppy during your workday?

Are you a student?

YesNo

What level of school are you in?

High SchoolCollegeOther

Have you talked to the appropriate administrators about bringing a dog on campus?

YesNot Yet

Why would you like to raise a guide dog or service dog puppy?

Do you currently have pets in the household?

YesNo

What kind?

Other dogsCatsBirdsOther

If you have other dogs in the home, what breed, and are they spayed/neutered

Please list name, breed, age, and other relevant info.

If you have other dogs in the home, how would you describe their current level of training?

Positive Reinforcement – We primarily used food, praise, play, etc. and avoided collar/leash corrections.Traditional Training – We used praise for good behavior and collar/other corrections for unwanted behavior.Mixed Methods – We used both food rewards and collar corrections.Other

Other, please describe

Who will be the primary caretaker/trainer for the puppy?

How old is the intended primary caretaker/trainer for the puppy?

If the primary caretaker is a minor, who is the responsible adult who will oversee the experience and provide support as needed?

Is anyone in the home allergic to or afraid of dogs?

YesNo

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Puppy Raiser Application Form

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