Service Dog Interest Application

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KSDT is proud to announce their new Service Dog Academy. This program will provide mobility or psychiatric (anxiety, depression, ptsd, autism) training for dogs that students currently own.

There will be an application process so we can appropriately gauge need as well as ability of the dog to successfully complete the program.

Our initial plan is a 9-12 month long training program that includes in-school training (FastTrack), in-home training, and training in new environments that a service dog will likely experience.

Dogs who complete this program will be tested for their AKC CGC title as well as the upcoming AKC ‘Service Dog Pass’.

More details will be provided soon. We invite anyone interested in the program to submit the interest form below in order to receive an application a week or so before the official application process opens.

Your Name: *

Your Gender: *

Female

Male

Prefer not to say

Other:

Your Height: *

Your Weight: *

E-mail Address: *

Phone Number: *

Please provide a description of your disability, how long you have had it, and how it affects your daily life: *

Are you able to provide a prescription or note from a medical professional stating your need for a service animal? If your answer is no, why not? *

Dog's Name: *

Dog's Age: *

Dog's Breed: *

Dog's Gender: *

Female

Male

Dog's Size/Weight: *

What level of training does your dog have? *

Puppy 1/Puppy 2

Beginner1/Beginner2

Intermediate

Advanced

Did they attend a program? If so, what is the name of the facility and length of time training there? *

What commands does your dog know that are RELIABLE (responds vast majority of the time)? *

What commands does your dog know the concept of (needs work)?
*

How long are you able to train your dog each day? *

What are your biggest training challenges? *

Has your dog ever been diagnosed as or treated for being (select all that apply): *

Reactive

Fearful

Anxious

Cautious

Having Separation Anxiety

Resource Guarding

Aggressive

None of the above

Required

If you answered yes to any of the options above, who diagnosed the dog and is your dog currently on any behavior medications? If you answered "None of the above" simply enter "N/A". *

What kind of service work are you hoping for your dog to be trained in? (select all that apply) *

Mobility

Medical Alert

Psychiatric

Required

Please provide two references that we are able to contact:

Reference #1 Name: *

Reference #1 Phone Number: *

Reference #2 Name: *

Reference #2 Phone Number: *

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