About You - Pre Application for a DBL Hearing 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.

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

Recipient Information

IMPORTANT: If you are filling this application out on behalf of another person, please fill in their information in this section.

Recipient's First Name

Recipient's Last Name

Recipient's Email

Mailing Street

Mailing City

Mailing State/Province

Mailing Zip/Postal Code

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

I am (recipient is) 18 years of age or older:

I (recipient) currently have a dog living in my home:

Please fill out this section only if you are submitting this application on behalf of another person.

Are you filling out this form for someone other than yourself?

If yes, please explain:

Submitter's First Name

Submitter's Last Name

Submitter's Email

Submitter's Mobile Number (i.e. xxx-xxx-xxxx)

How did you hear about Dogs for Better Lives?

What led you to consider applying for a Hearing Dog?

How do you envision incorporating a dog into your daily routine?

How will you utilize the dog’s trained skills?

When thinking about your schedule, in what environments do you envision utilizing a Hearing Dog?

In what ways would having a Hearing Dog make a difference in your 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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Contact Information