Guide Dog Foundation

Our Programs

Guide Dog Foundation Application Request Form

Before you fill out the Application Request Form, please make sure that you reviewed and understand the Program Admission Information. Once the Guide Dog Foundation receives your request form, it will be reviewed to determine if we can train and provide a guide dog for you. Only qualifying applicants will receive a detailed application within fifteen (15) business days. Please note that completing the Application Request Form does not guarantee acceptance as a client at the Guide Dog Foundation.

Please fill out the form below if you are interested in receiving an application for a guide dog provided by The Guide Dog Foundation.

All information provided is privileged and will be considered confidential.

All fields are required to be filled out.


Contact Information  
First Name
Last Name
Email
Date of Birth
Address: Line 1
Address: Line 2
City
State
Zip / Postal Code
County
Primary Phone
How did you hear about us?
Type of dog applying for?
Are you legally blind?
How long have you been blind of visually impaired?
(Minimum 1 year post injury or diagnosis to apply)
Did you have Orientation and Mobility Training?
When did you complete your Orientation and Mobility Training?
Does anyone else live with you in your home? If yes, please list relationship.
Number of pets and type: (dog, bird, etc.)
What would you like your guide dog to do for you?
Please describe how your disability affects your life and your current level of independence:
Why do you wish to partner with a guide dog?
Please list any secondary disabilities that you have:
Name of the person completing this form:
    
I acknowledge that I have read the Program Admission Information and understand the eligibility requirements.
    
Would you like an electronic or paper application to be sent to you?