Tell us about yourself Step 1 of 29 3% Name First Last How Should I Address You?Mr.Mrs.Ms.OtherWhat is your preference? Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email Phone Age Range0 - 1818 - 2526 - 3030+50+ Please share your primary reason for reaching out.I am interested in a career change dogI am inquiring about a service dog for myselfI am inquiring about a service dog for a friend for family memberI am inquiring about a service dog for someone elseI would like information about Service dog Education, Speaking Engagement or other Educational InquiryI am inquiring about obtaining a career-change dogOther Why do you want a Greatdogs Career Change Dog? Please list the name, age, and relationship of the rest of your household. How long have you lived at your current address? Do you rent or own?OwnRent Do you have a fenced in yard?YesNo Is anyone in your home allergic to dogs?YesNo Have you taken a dog through obedience classes? YesNo Are you willing to use a crate?YesNo What is the number of hours per day the dog would spend alone? Where would the dog be alone? Please list all pets currently in your home. Please list current veterinarian including phone number and address. What do you do for a living? Are you willing to seek, acquire and take financial responsibility for any additional training?YesNo Please check the characteristics that you are able and willing to work with: Aggression (dogs, cats, small animals) Aggression (People) Assertiveness Excessive Barking Excessive Energy Level Fearful Behavior Inappropriate Chewing/Digging Separation Anxiety Toileting Issues Training Issues Are you attending a local college or university?YesNoAre you enrolled online or in-person?OnlineIn-person Are you currently on a waitlist for a service dog with any other organization?YesNoWhat is your current status?PendingIn Funding StageApprovedWaitlistedFully FundedOtherPlease explain Tell Us About Your Support SystemWho would support you through the process of acquiring a service dog? Walk me through a day in your life. What do you enjoy doing? What challenges do you face? Tell me your story? What do you feel is important for me to learn about you and your support system? We would love to dig deeper, what is the best way to contact you? To make the most of our time together, what do you hope to take away from our initial conversation?I have a question!How did you hear about our program?*FriendBrowsing the InternetFamily doctor or medical specialistBreeder or dog professional
