Main menu

 

PAWS DOG

APPLICATION REQUEST


Please review the Application Process and Frequently Asked Questions before completing the Application Request Form.  Once PAWS receives an Application Request, it will be reviewed to determine if the applicant meets PAWS' program guidelines. Qualifying applicants will be mailed an application to complete and non-qualifying applicants will receive a notice in 10-14 business days. Please note that completing the Application Request or the PAWS Dog Application does not guarantee acceptance as a PAWS Client.

 

Paws with a Cause

PRIVACY POLICY 


By submitting this form on PAWS’ website, you agree to the terms and conditions of the Privacy Policy.

Request an Application


Applicant First Name (*)
Please type your full name.

(This form MUST be completed in the name of the applicant)

Applicant Last Name(*)
Please type your last name.

Applicant Birth Date(*)
Invalid Input

Name of person completing this form/relationship to applicant(*)

Phone Number(*)
Invalid Input

Alternate Phone Number
Invalid Input

How did you hear about Paws With A Cause?(*)
Invalid Input

Address Line 1(*)
Invalid Input

Address Line 2
Invalid Input

City(*)
Invalid Input

State(*)
Invalid Input

Zip Code(*)
Please, use a valid USA zip code

E-mail
Invalid email address.

What would you like an Assistance Dog to do for you?(*)
Invalid Input

I acknowledge that I have read the Admissions FAQs and Application Process(*)
Please, accept the agreements

Assistance Dog Type(*)
Please select one type of Assistance Dog. Then, complete application according to your response.

Hearing Dog (for a person who is deaf or hard of hearing)

Service Dog (for people with physical disabilities)

Seizure Response Dog

Combination Dog (Service/Hearing Dog, Service/Seizure Response Dog, Seizure Response/Hearing Dog)

Service Dog for A Child with Autism (child must be between 4 - 12 years of age (PAWS must receive the application prior to a child’s 7th birthday; must have a completed Needs Assessment by a child’s 9th birthday; placement must occur prior to a child’s 12th birthday)

Please list all diagnosed disabilities and date of diagnosis(*)
Invalid Input

What tasks or skills would you like a Hearing Dog to do for you?(*)
Invalid Input

What tasks or skills would you like a Service Dog to do for you?(*)
Invalid Input

What tasks or skills would you like a Seizure Dog to do for you?(*)
Invalid Input

What types of seizures do you have? (grand mal, petit mal, partial-complex, cluster, absence, etc.)(*)
Invalid Input

What is the frequency of each type of seizure (daily, weekly, monthly, etc.)?(*)
Invalid Input

What tasks or skills would you like an Assistance Dog to do for you?(*)
Invalid Input

My child exhibits (check all that apply)(*)

Invalid Input

My child also exhibits
Invalid Input

My child is currently in (check all that apply)*(*)

Invalid Input

My child is also currently in
Invalid Input

Please describe the effects of autism on the child and the family
Invalid Input

FacebookTwitterDonateBLOG