About You - Pre Application for a DBL Autism Assistance Dog

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Below is a series of questions to help us get to know you better. We ask that you answer these questions with as much information as possible as it will help us better understand your needs.

Yes, I have read the Frequently Asked Questions and watched the video.

Child's First Name

Child's Last Name

Parent/Guardian First Name

Parent/Guardian Last Name

Additional Parent/Guardian First Name

Additional Parent/Guardian Last Name

Parent/Guardian Email

Mailing Street

Mailing City

Mailing State

Mailing Zip Code

Mobile Number (i.e. xxx-xxx-xxxx)

My child is between the ages of 5-12 yrs:

Child's Birthdate:

I currently have a dog living in my home:

How did you hear about Dogs for Better Lives?

What motivated you to explore the possibility of an Autism Assistance dog for your child and family?

How do you see an Autism Assistance Dog fitting into your child’s daily routine?

How might the dog’s trained skills support your child’s unique needs?

When thinking about your child’s daily life, in which situations or environments do you envision utilizing an Autism Assistance Dog?

In what ways would having an Autism Assistance Dog make a difference in your family’s and child’s life?

Tell us a little about yourself and your family. What would you like us to know about you to support you and your application?

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