Service Dog Interest Form
Thank you for taking the time to complete this form.   We  are hoping to capture information about each potential recipient through this form.  

During the last year, we have gained a lot of experience and insight into the dogs and best practices for our program.  

We will no longer accept applications for recipients who are under age 7 at the time of application submission.

We strongly prefer that potential recipients be the full-time handler of the service dog.

We ask that all families reside within a 50 mile radius of our facility, W383 Carlin Trail, Palmyra, WI 53156.  This is due to the requirement of traveling to our location once per week for hour-long training sessions for approximately 12 months.  

An attendance policy is enforced for training sessions.

We are now requiring a $500 application fee, due at the time of a scheduled family meeting at our facility.

An agreement regarding our program must be signed before training can begin, and a withdrawal fee will be assessed if you choose to leave the program after 90 days of training with a dog.


Our goal is not only to provide a service dog to a child with autism, but to ensure that we are making the best matches for both the dog and the recipient.  Our dogs are custom trained for their specific recipient, which requires a lot of time, effort and funding from multiple people/sources.  Our screening process is lengthy and is utilized to help us make the best matches for our dogs and their recipients so that they can be mutually beneficial to each other.  Not everyone will qualify, nor will everyone who qualifies want to proceed with  the process once they learn the details and how extensive the process is.  

Completing this form is not a guarantee of acceptance into our program or that the potential recipient will receive a service dog from DogsInVests, Inc.
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Email *
Contact Name: *
Contact Phone: *
Contact Email: *
Potential Recipient Name: *
Potential Recipient Date of Birth: *
Potential Recipient Address:  *
Does the potential recipient reside within a 50 mile radius of: W383 Carlin Trail, Palmyra, WI 53156? *
Required
Has the potential recipient been diagnosed with autism by a licensed medical professional? *
Required
What are three area's you envision a service dog assisting the potential recipient? *
Is the potential recipient familiar and comfortable with dogs?  Please explain their experience with dogs. *
Does the potential recipient have any fears or anxiety in regards to dogs or animals? *
Are you willing to commit to 12-18 months of weekly visits to our location for one hour training sessions?  (We ask that all recipients be located within 50 miles of Palmyra, Wi.) *
Does the potential recipient attend school? *
Required
Do they have an IEP? *
Required
Are they verbal or non-verbal? *
Required
If non-verbal, can they communicate with sign language or hand signals?  Please explain how they communicate below.
Do you wish to continue to be on our candidate pool list? *
Required
If you no longer wish to be on our waiting list and your willing to share, why not?
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