Service Dog Application

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We are only accepting applications for fully trained Psychiatric Service Dogs through this application.

If you are interested in training your own dog as a service dog, please visit our 'Owner Trained Service Dogs' page.

All applicants will be considered, regardless of race, sex, religion, creed, sexual orientation and ethnic origin.
Unless otherwise noted, please provide applicable information for prospective Service Dog Handler.

Please be aware that acquiring a Service Dog is a large financial commitment up to $30,000. If we find a match that we believe will meet your needs, we will discuss the details of your specific situation and what the exact cost of your service dog will be.

If you answer "No" to any of the following 4 questions, you do not meet our application criteria at this time.

1) Do you have a psychiatric disability as defined by the ADA?

2) Are you aged 12 - 22 years old?

3) Have you been in therapy for at least 1 year?

We're very sorry, but you do not meet our application criteria for a Program Trained Psychiatric Service Dog at this time. Depending on your situation, you may qualify for our Owner Trained Service Dog program.

You can search for other organizations & programs through the ADI website here

Preferred First Name

Last Name

Legal Name

Preferred Pronouns

Date of Birth

Parent or Guardian if applicant is a minor

Street

City

State

Zip Code

Mobile Phone

Emergency Contact

Emergency Contact Phone

Emergency Contact Email

Emergency Contact Relationship

Include emergency contact in emails?

Name of Therapist/Doctor managing diagnosis

Therapist/Doctor's phone

Therapist/Doctor's email

Have you discussed this with your doctors?

Have you discussed this with your family or caregivers?

Letter from your doctor/therapist is optional for the application but required for final decision. If a letter is not attached to the application, we will contact you for this prior to final approval. Letter must confirm that applicant:
(1) is disabled as defined by ADA
and
(2) has been in therapy for at least one year - has a proper support system in place for working with and caring for a dog.

Please attach letter from your doctor or therapist here:

Have you ever served in the military?

Occupation / former occupation

Do you own or rent?

Do you have a fenced in yard or other way to provide exercise?

Is anyone in your home allergic to dogs?

Have you ever had a dog before?

Tell us about your experience with dogs.

Tell us a little about your support system:

Do you use a local vet?

Current vet contact info

Do you have other dogs in your home and are they spayed or neutered?

Are your other dogs friendly?

Please list any other pets in the home:

Does anyone in your home smoke?

Are there any guns in your home?

If yes, will you take your dog to the shooting range?

What are your hobbies?

What is your current disability diagnosis?

Were you diagnosed more than one year ago?

Please explain briefly how your disability affects your life and current level of independence.

How does your disability impact your education?

Please give us a brief history of your disability. (Please do not include abbreviations or initials when discussing your disability.)

Will you have time to spend with a dog?

How many hours a day will your service dog be alone?

Will you be able to clean up after your dog goes to the bathroom?

Will you be able to take your dog to the veterinarian?

Will you be able to groom your dog?

What types of transportation do you use? (Hold 'Ctrl' key to select multiple options.)

Will your service dog accompany you on vacation?

Will your service dog accompany you to work or school?
(Hold 'Ctrl' key to select multiple options.)

What specific needs or services do you feel a service dog can provide for you?

If I get approved to receive a service dog from The Exceptional Sidekick, I agree to travel to Newtown, CT for weekly team training classes for up to one year, based on assessed need by The Exceptional Sidekick's trainers.

I understand that the estimated yearly cost of caring for a service dog is roughly $2,500 and I understand that I am responsible for those expenses and obtaining medical insurance for my dog.

I understand that if I am approved for a service dog from The Exceptional Sidekick, I will be subject to a criminal background check prior to the dog being placed in my care.

I understand that I will be asked to support The Exceptional Sidekick through fundraising and donations. The Exceptional Sidekick will help me by providing support, ideas and all marketing materials that fit my ability. The Exceptional Sidekick cannot survive without my support as well as my family's support. I will take pride in supporting them as they prepare dogs for a life of service work.

While everyone has different abilities, I am capable of contributing time and energy to an organization that means so much to me.

I understand that applying for a service dog does not guarantee the placement of a service dog.

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