Military service dates  (if applicable)

MOS  (if applicable)

ETS Date  (if applicable)

First Responders - Profession and Town of Service 

Do you have any disabilities? PTSD, TBI, depression, cancer, physical impairments etc. if yes, please list how symptoms/severity impacts daily life.

Disability Rating if applicable 

Spouse if applicable and number

Current Employer and number 

Please list ages of adults and children as well as any special needs/disabilities etc:

Does anyone in the household have allergies to dogs/animals? 

If yes explain severity  -

If rent please, give your landlord’s name and phone number so may verify that you are allowed to have pets: 

Will you need any formal documents to have a dog approved by the landlord?

Do you have backyard? Is it fenced? Height of fence? This is not a requirement for adoption. 

Have you owned a dog in the past? Or do you currently?

If so, how many, type, age, temperament?

Does anyone smoke with in the home? 

Please provide the name and number of a non-family member that we may contact as a reference. 

Are you able to handle all of the dog's physical needs of daily exercise and care?

If you have any physical limitations please explain.

Would you consider your home environment to be laid back, high energy or even paced?

What does a normal day look like for you?

What do you do with your down time?

What activities do you like to do?

How would you describe yourself?

Do you or have you ever struggled with substance abuse? Drugs, alcohol.

How many drinks do you have per week?

How manageable is the daily stress in your home without a puppy?

What are your stressors?

What stress management skills do you currently have?

Do you have any triggers and what are they?

Do you have a good support system? If yes, please list those in your support system.

How would you rate your mental health right now on a scale of 1-10?

Optional - This is for internal data, will not be shared and will not effect your application.

Do you now or have you had suicidal thoughts/intentions?

Do you currently see a therapist? If so how often.

Would you be interested in our 1:1 or group counseling sessions through 22Mohawks?

Please provide the best day and time of day to schedule a home visit either in person or via zoom

Have you or anyone in the household ever been convicted of a felony? 

If yes please explain.

Please share any other information you find necessary for us to know about yourself and reasons for wanting to take part in the GoHawks 10 week dog training program.

If opting in to keep the pup during off hours please be aware the dog must be with you 24/7 unless a small gap of time for 20/30 min if absolutely needed. 

How did you hear about 22Mohawks and or GOFI?