Apply for a Guide Dog

Please complete the application form in its entirety.  All fields are "Required" before you can submit the application. For an overview of the guide dog training program click HERE. To learn more about program admission, click HERE.

This online application is Part One of our application process.  Once you have submitted the application below, a member of our team will contact you within 3 business days. As your application proceeds, we may require additional documents, including a medical report to be completed by your physician, an Orientation and Mobility Specialist’s report, an ophthalmology report, and application video.  Please note that the completion of the following application form does not guarantee acceptance as a client at the Guide Dog Foundation.  

All information provided is privileged and will be considered confidential.

For Screen Reader Users:

The application below includes a number of fields.  You will be required to use the "Tab" button, "Arrow" keys or other keys specific to your screen reader in order to navigate through the application.  

Once you submit your application, you should be directed to a message that verifies that we have received your application.  If you are not directed to that page, you will be re-directed to the top of the application where you will find a list of fields that must be completed before you will be able to submit your application.

If you cannot navigate the form, or your browser does not support forms, please contact Consumer Services for assistance at ConsumerServices@GuideDog.org or call (866) 282-8047.  A Word Document application is available by request.

PERSONAL INFORMATION


First Name (Legal Name) *Required
   

Last Name *Required   

Home Street Address 1 *Required   

Home Street Address 2  

City *Required   

State/Province *Required   

Zip code/Postal Code *Required   

County  

Country (Click first letter for shortcut - leave blank for United States)   

Home Phone (Include area code) *Required   

Cell Phone (Include area code) 


Email *Required   

Date of Birth (MM/DD/YYYY) *Required   

Gender  

Height *Required   

Weight *Required   

For statistical purposes, what is your ethnic background? 


Are you legally blind?  

Year of vision loss (Enter four digit year) *Required   

Cause of blindness *Required   

Amount of vision *Required   


Do you have hearing loss? *Required    

If so, what degree of loss?  

Other physical disabilities  

 

Please describe how your disability affects your life, and your current level of independence.  

 


 

Are you a veteran? *Required  

If yes, what branch of service? 

If yes, what campaign did you serve? 

If yes, were you honorably discharged? 

If discharged, please provide a copy of your DD-214 (Member-4) by sending a copy to: Jaclyn@vetdogs.org, Fax: 631-930-9075 or mail: America’s VetDogs Consumer Services, 371 E. Jericho Tpke. Smithtown, NY 11787.


Are you currently employed? *Required  
If yes, what is your present occupation?

Have you ever had a drug or alcohol abuse problem? * Required  

Have you ever been convicted of a felony? *Required  


If yes, please provide details 

Are you currently seeing any of the following specialists? *Required (Please check all that apply.) 

Have you had mobility instruction? *Required
  


If so, when? (Enter four digit year)  

What type of mobility aid do you use primarily? *Required  

Do you cross streets without assistance from other people? *Required  

Do you currently have, or have you had a guide dog before? *Required
  


If yes, from where? 

Other school  

On average, how many blocks do you independently walk each day? 

Please list up to 3 destinations that you independently walk on a regular basis. Please list the mailing address if available. *Required
Destination 1:  

Destination 2:  
Destination 3:  

Determining factor in your decision to apply? *Required  

Correspondence Preference 

Above statements have been truthfully answered *Required  


CONSENT TO RELEASEUse your "Arrow" keys to navigate and read the information below. This Consent section of the form must be signed below.


This authorization shall become effective immediately and shall remain in effect for a three-year period from the date it was signed.  This is to authorize any physician, hospital, firm, organization or person to furnish to the Guide Dog Foundation for the Blind, Inc. and America's VetDogs - the Veteran's K-9 Corps (hereinafter referred to as "GDF & AVD"), all information, material or opinions that may be requested by GDF & AVD concerning me.  GDF & AVD are further authorized to copy any records pertaining to me.  I hereby waive any privilege I have to said information to GDF & AVD, and agree to hold GDF & AVD blameless from any claims as a result of the sharing of information related to me.

The Information received by GDF & AVD, will only be used to evaluate my application for a guide or service dog and training in the use thereof.  

I understand that any information provided to GDF & AVD will remain confidential. 

I understand that my failure to disclose any medical or personal information that pertains to my ability to work with an assistance dog may result in the denial of my application or termination of training.

By clicking “Submit” with my name typed below, I agree to submit this application, which includes the Foundation Code of Conduct and the Consent to Release form, by electronic means and adopt such process with the intent to sign this form.

Please type your full name and this will serve as your signature.

Applicant’s name / parent guardian if applicable *Required (type full name in box)  

Date (MM/DD/YYYY) *Required  

 

If it is determined that you are qualified to participate in our guide dog training program, you will be invited to continue with Part Two of the application, which includes a medical report, O&M report, ophthalmology report, and application video.  Would you prefer these forms be sent to you by mail or electronically?