Embrace A Vet, Inc. · Paws for Peace Application

General Information

Name

*

First Name

Last Name

Gender

Date of Birth

*

(mm/dd/yyyy)

Address

*

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

County

*

Phone

*

Email

*

Marital Status

*

Name of Significant Other or Support Person

First Name

Last Name

Military Information

Embrace A Vet requires a copy of your DD214 as part of your application.

Do you have a service-connected diagnosis of PTS?

*

What branch did you serve?

*

Dates of Service:

*

Personal Information

As part of the application, Embrace A Vet requires submittal of a Therapist Referral and Release of Confidential Forms.

Embrace A Vet requires all participants in the Paws for Peace PTS Service Dog Training program to be in therapy during the program. Are you currently in Treatment/Therapy/Counseling?

*

Other than PTSD and/or TBI, are there any physical or mental health issues and/or limitations we should know about?

*

Do you have any other special accommodations for any physical disabilities? If yes, explain.

PTS Service Dog Information

Do you have a dog you would like to use as a potential service dog?

*

Please list the gender, age, and breed of the dog:

Dog Suitability

Your dog will require an evaluation as to its suitability to be trained as a service dog. We also require a Veterinarian Release. If your dog is not appropriate for the program are you willing to move ahead with a different dog?

Are you interested in Embrace A Vet pairing you up with a suitable potential service dog?

Program Requirements

*

Upon acceptance into the PTS Service Dog training program, you will be required to attend weekly, 2 hour sessions for a total of 20 weeks. You will be expected to log an additional 100 hours of independent training using the methods and tools learned in class in order to complete the course. Part of the training requires classes to be held in places like Home Depot, Petco or restaurants in order to train the dog how to behave in public situations. Are you willing to make this commitment?

Are you able to financially care for a dog, i.e. food and veterinary service if needed?

*

Are you able to exercise a dog, i.e. walking/biking/running?

*

Housing Information

If you live in a rental, you will need permission from your landlord to have a service dog in training. Please provide a letter from your landlord. Embrace A Vet requires a signed document which indicates a veteran’s support person is knowledgeable about the application for service dog training, supports the process and the on-going follow-up. In addition, two individuals have to agree to provide support to the veteran/canine team, have 24/7 access and agree to provide an immediate and temporary home for the dog should an emergency arise.

What type of residence is your home?

*

How long have you lived there?

*

Please list everyone who lives with you or visits regularly and their age:

*

Does your home have a fenced yard, enclosed area or other space for a dog to exercise?

*

Please describe your outdoor space:

Do you have any other animals/pets/livestock?

*

Please list any other animals/pets/livestock:

Employment Information

Are you working?

*

Please describe what you do and your hours:

Please submit a letter from your employer permitted you to bring your service dog in training or service dog to work.

Additional Comments

Referral Information

Where did you hear about us?

*

Paws for Peace Policies

Paws for Peace PTS Service Dog Training Program is provided without cost to participants.
Veterans need to be current Maine residents.
Embrace A Vet’s programs are substance free (other than prescribed medication).
No weapons are permitted during our programs.
I am aware Embrace A Vet will conduct a criminal background check.

*

Yes, I understand and agree to these policies

Please Read

Once your completed application is received and processed we will contact you about our next scheduled Orientation.

Please understand that your application will not be processed as completed until the following supporting documents are furnished to Embrace A Vet:
• DD214 • Therapist Referral Letter • Release of Confidentiality • Veteran/Canine Support Document • Landlord Release (if applicable) • Employer Release (if applicable) • Veterinarian Release (if applicable)

Download Referral Form

Click here to download our Paws for Peace Referral Form. Please have your mental health provider fill it out and submit along with DD214.