All WFSD Clients must be formally diagnosed with a service induced brain injury such as PTS, TBI, etc and provide documentation stating such.

WFSD program is specifically for veterans with service induced brain injuries such as PTS, TBI, etc. The program considers applications regardless of race, sex or religion.

Clients are not required to participate in fundraising or public relations activities without their expressed and voluntary permission.

In order to qualify for WFSD services you must meet ALL of the following qualifications. The only cost to our client is that of a background check in Stage 4 which is ~35.00 and paid directly to the background provider. . 1. Diagnosed by a medical provider with brain injuries such as PTS, TBI 2. Be able to attend training sessions twice a week for 8/9 weeks in Flintstone, GA.

After completing this online Veteran application you will be emailed a link to Part 2 and need to complete and return the following to WFSD:

Self Report Assessment
Verification of a clear diagnosis of PTS through one of the following:
WFSD Medical Reference Form
A Copy of Your DD214 Form

AFTER ALL OF THE ABOVE ARE RECEIVED WE WILL CONTACT YOU TO SET UP A TIME TO CONDUCT A PHONE INTERVIEW.

WARRIOR FREEDOM SERVICE DOG, INC QUALIFICATIONS:

All WFSD Clients must be formally diagnosed with a service induced brain injury such as PTS, TBI, etc and provide documentation stating such. Will you be able to obtain this documentation from your provider?

All WFSD Clients must be able to attend training at our facility in Flintstone, Ga TWICE a week for 8 weeks so 16 training sessions total over 8/9 weeks. Are you located where you will be able to make these required training sessions?

All WFSD clients must have a valid DD214. Will you be able to provide us with a copy of your DD214?

All WFSD Clients must complete a background check to ensure the safety of our team and dogs. (Negative results will not necessarily disqualify you.) Have you been convicted of a violent crime?

WFSD pairs each dog based on the clients specific need(s), personality, and the dogs' abilities and personality. We do NOT have the resources to allow clients to use their own dog. Will you be totally on board with this process?

All WFSD Clients must provide the names and contact information for two (2) individuals, ie: family members, friends, teachers, caregivers, therapists, who have agreed to provide support to them and their assistance dog. It is best for one of these contacts to live outside the home of the WFSD Client and within 2-3 hours from the client’s home address in order to help facilitate immediate access and a temporary home to the dog if necessary.

Will you be able to provide this information?

All WFSD Clients must provide consent for their health provider to complete our Mental Provider Health Form.

Are you willing to do this?

WARRIOR FREEDOM SERVICE DOGS, INC APPLICATION

After completing this online Veteran application you will be emailed a link to the following paperwork that you will need to complete and return the following to WFSD:

Self Report Assessment
Verification of a clear diagnosis of PTS through one of the following:
WFSD Medical Reference Form
A Copy of Your DD214 Form

AFTER ALL OF THE ABOVE ARE RECEIVED WE WILL CONTACT YOU TO SET UP A TIME TO CONDUCT A PHONE INTERVIEW. ***WE ARE HERE TO HELP YOU WITH THIS; SO, PLEASE REACH OUT AND LET US KNOW IF YOU HAVE ANY ISSUES OBTAINING ANY OF THE ABOVE PAPERWORK***

Application Type

PERSONAL INFORMATION

First Name

Last Name

Street Address

City

State, Zip

Time at Address

Alternate Email

Home Phone

Cell Phone Number

Other Phone

Biological Sex

Birthdate: using this format 01/01/1950

Household Number: How many people live in your household? (If only you just put 1)

Household Members: Please give names/age/relationship to you for each member living in your household (If no one lives with you, just put none or NA):

EMERGENCY CONTACT PHONE NUMBER

EMERGENCY CONTACT NAME & RELATIONSHIP

EMERGENCY CONTACT EMAIL

Do you currently own any pets

Pets: Pets you currently own: (Specify species, age, breed, etc or None)

Due to the complications of having a highly trained service dog homed with dogs as “pets” would you be willing to rehome your “pet” dog if WFSD finds their service dog would NOT be compatible with your pet?

Do you currently have a Veterinarian?

Veterinarian Address & Phone (If no pets just put None or NA)

Veterinarian Permission: Do we have permission to contact the Veterinarian listed above

VETERINARIAN ASSISTANCE: Would you like us to assist you in obtaining or maintaining veterinarian care?

Veteran Home: Describe your home and neighborhood (house, apartment, mobile home, size of yard,city suburb, country, etc.)

Home

Do you own or rent your home

Landlord's Contact information: Name, Phone, email or NA if you own your home

Landlord Permission: Will you be able to obtain written permission from you Landlord:

Describe your Property

Neighborhood

Water: Do you have a swimming pool, pond, creek or other body of water on or near your property?( please describe) (*Is there a secure fence around the swimming pool? Is there fencing that securely encloses a dog area away from bodies of water?)

Fenced Back Yard

Fence Type: If fenced back yard, please describe the fence. *If possible please provide a picture of your fenced yard by mail or email attachment. If No fenced yard, please explain a location for dog to exercise (eg: walk in neighborhood):

MILITARY/WORK HISTORY

Please note, branch of service, term of service, rank, and disability rating are for informational purposes only and are not factors used to determine eligibility for services through Warrior Freedom Service Dogs. Decisions of eligibility of service will be determined by the board.

Are you a Veteran who served in a COMBAT THEATER?

Dates of Service (MM/DD/YY)_______to____

Which combat theater/war(s) did you serve

Military Service: Branch

Rank & Occupation

Rate/Pay Grade

Do you receive any Veteran Services

If yes, what were they?

Do you see a therapist regularly?

Are you currently in counseling?

Current employment/ Source of Income

Full or Part time

Employer

Employer Contact Information (If not working just put None or NA)

Number of hours per week (If not working just put None or NA)

Length of Employment (If not working just put None or NA)

Educational degrees: (If no educational degrees just put None or NA)

Name of school, college, or university (If no school, college, or university just put None or NA)

BACKGROUND HISTORY:

The staff of Warrior Freedom Service Dogs understands that these questions are often sensitive areas to discuss, especially with unfamiliar people. However we are very welcoming to discussion to clarify any issues you might have in this category. Your answers will not disqualify you from acceptance

Substance Abuse Treatment: Are you currently or have you ever received treatment for substance abuse?

OTHER

Service Dog Applicant: Have you applied for a service dog from a private organization?

Service Dog Org: If yes, please provide the name of the organization, contact information and date of application:

Service Dog Denial: Have you ever been denied a service dog by an organization?

Denial Information: Please give the reason you were denied

NONRELATED Reference: Name/Phone/Relationship

NONRELATED Reference: Name/Phone/Relationship 2

Multipart Application Understanding: I ALSO UNDERSTAND THAT THIS IS ONLY PART OF THE APPLICATION PROCESS, AND THAT I MUST PROVIDE FURTHER DOCUMENTS TO WFSD ACCORDING TO THE OTHER PARTS OF THE APPLICATION PROCESS. STEP 2 OF THIS STAGE WILL BE EMAILED TO YOU UPON SUBMISSION OF THIS APPLICATION. I FURTHER UNDERSTAND THAT I WILL BE REQUIRED TO PAY FOR A BACKGROUND CHECK ONCE THE PHONE INTERVIEW IS APPROVED. THIS WILL BE THE ONLY COST I WILL INCUR IF ACCEPTED INTO THE PROGRAM. ADDITIONALLY I UNDERSTAND I MUST COMPLETE THE FOLLOWING 10 STAGES BEFORE THE OWNERSHIP OF A WFSD SERVICE DOG WILL BE TRANSFERRED TO ME. WFSD Application Stages

I ACKNOWLEDGE THAT I UNDERSTAND:

AUTHORIZATION TO CONFIRM INFORMATION: I CERTIFY THAT ALL INFORMATION PROVIDED IN THIS APPLICATION IS TRUE AND COMPLETE, AND I UNDERSTAND THAT ANY MISSTATEMENT, FALSIFICATION, OR OMISSION OF INFORMATION IS GROUNDS FOR WARRIOR FREEDOM SERVICE DOGS, INC. TO REFUSE SERVICES. I AUTHORIZE ANY OF THE PERSONS OF ORGANIZATIONS OR INDIVIDUALS REFERENCED IN THIS APPLICATION TO GIVE ANY OTHER INFORMATION THEY MIGHT HAVE, PERSONAL OR OTHERWISE, WITH REGARD TO ANY OF THE SUBJECTS COVERED BY THIS APPLICATION. I AUTHORIZE WARRIOR FREEDOM SERVICE DOGS, INC. TO REQUEST, RECEIVE, AND VERIFY ALL INFORMATION GIVEN ON THIS APPLICATION. I UNDERSTAND THE ABOVE INFORMATION AND AGREE TO THESE CONTENTS. I UNDERSTAND THAT ALL OF THE INFORMATION I PROVIDE TO WFSD WILL BE KEPT CONFIDENTIAL AND ONLY WFSD ORGANIZATION MEMBERS WILL HAVE ACCESS UNLESS I GIVE EXPRESS PRIOR PERMISSION.

Signature: Please provide an electronic signature by filling in your first, middle, and last name below.

Contact Information