Service Dog Program

Before beginning the application process into The Duncan School Service Dog Program please make sure to have the documents below ready. You'll be required to upload them throughout the application. Please allow ample time to finish this form and answer everything honestly and clearly. The information collected ensures the Service Dog program is held to the highest standards and allows the trainer to teach the Handler the correct tools needed during the training. The information on this form is not shared outside of the program's need-to-know based staff (trainers); we respect your privacy.

Please be ready to upload the following:

1. The handler's medical letter suggesting a Service Dog could help mitigate the disability. This must be written on the doctor office's letterhead, signed, and dated by a mental health physician or MD.

2. The dog's vet records for up to date vaccine records, monthly prevention medication, and orthopedic vet records clearing the dog for mobility tasks (if they are needed).

3. The Handler's Headshot

Handler's information (Parent's if the handler is a child under 18)

First Name

Last Name

Email

Phone

Birthday

Who referred you or how did you hear about the program?

The potential Service Dog's information

Dog's Name

Dog's Breed/Mix

How long have you had this dog?

Dog's Age

Which best describes the dog's training for basic obedience (sit, down, stay, heel....)

Checkbox Description

Professional Obedience Training
Owner DIY Training
No training
Other, please explain

Other

Dog's Current Weight

Less than 10lb
10-30lbs
30-50lbs
50-75lbs
75-100lbs
More than 100lbs

Dog's current height (measure floor to the top of the shoulder blades/withers)

Dog's Behavioral Evaluation

Do you have any Behavioral concerns for your dog?

*Reactive means barks, lunges, jumps towards. Not Neutral.

Shy, Fearful, or reactive towards People
Shy, Fearful, or reactive towards other Dogs
Shy, Fearful, or reactive towards Cats
Shy, Fearful, or reactive towards Wildlife
High Anxiety
Resource Possessive (food, toys, you, etc)
Shy, Fearful, or reactive towards moving objects (cars, bikes, etc)
Other - Please Explain
N/A - My dog is relaxed and I don't have a behavioral concern

Explain these behavior concerns in detail.

Other

When did this or these behaviors start?

Has this behavior...

Improved
Become worse
Stayed the same

Bite History

Bite History with people

Has never growled or bitten
Has growled or snapped but NO bite
Bite Occured
Bite, required medical care

Bite History with dogs

Has never growled or bitten
Has growled or snapped but NO bite
Bite Occured
Bite, required medical care

Bite History with cats/other animals

Has never growled or bitten
Has growled or snapped but NO bite
Bite Occured
Bite, required medical care

Training Goals

What type of tasks do you think would help mitigate your disability?

What training aids do you currently used

Flat/Normal Collar
Harness
Metal Prong Collar
Plastic Prong Collar
Martingale Collar
E Collar
Head Collar (Haltie, Gentle Leader, etc)

Any additional information about your dog we need to know?

Dog's Health

All dogs participating in training at The Duncan School are required to be up to date on all their annual vaccines including deworming and receiving monthly preventive medications for heartworm and preferably flea/tick. Please upload a copy of your dog's medical records from your veterinarian.

Handler's Health & History

Who will the service dog be for?

Adult 18+
Child Under 18

If the Service Dog is for a child, how old is the child?

If the Service Dog is for a child, does he or she have a verifiable medical need for a Service Dog?

Yes
No

If the Service Dog is for an adult, do you have a verifiable medical need for a Service Dog?

Yes
No

Handler's life style

About You: Please tell us about the Service Dog's handler

Describe your typical daily routine.

Anger and Stress: How do you deal with your anger and stress?

Emotional: provide an example of a time when you were faced with an emotional conflict and the steps used to resolve the conflict.

Personal Confrontation: How do you deal with personal confrontation?

Anxiety or PTSD: If you experience anxiety and/or other symptoms of PTSD, please list the most common triggers

Handler's Job - All Answers Required if Employed

Are you currently employed?

Yes
No

Employer Name

Work Environment: Please describe your work environment (large/small office, high rise, downtown, suburban, rural location, indoors, outdoors, etc.)

Job Functions: Please describe your job function(s) and a typical work day

Does your employer know you're applying for a Service Dog?

Yes
No

Do you want the Service Dog to accompany you to work?

Yes
No

Reasonable Accommodation Requests

If you need your employer (or school) to modify or provide an exception to any policy so that your Service Dog may accompany you, it's in your best interest to start the process of making a Reasonable Accommodation Request 90 days before training. For example, Reasonable Accommodations allow handlers to be accompanied by their Service Dog despite a no pets policy, have a crate in your workspace, and/or take short additional breaks. It is your responsibility to make your Reasonable Accommodation Requests.

Current Student Handlers - All Answers Required if the Handler is a Current Student

Where do you attend school?

Where are your classes held?

Online
On Campus
Online & On Campus

School Environment: Please describe your school environment (large/small, downtown, suburban, rural location, indoors, outdoors, etc.)

Will the Service Dog attend class with you?

Yes
No

Handler's Medical History

On a scale to 1 (being non-verbal) to 5 (fluent, clear communication), please rate your Verbal Skills

On a scale of 1 (weakest) to 10 (strongest), please rate your physical strength.

On a scale of 1-10, please rate your activity level. (Activity is the amount of movement you may do throughout the day.)

What is your dominate hand

Right
Left

Do you have a history of falling?

Yes
No

Please list any physical limitations we need to be aware of during class - illnesses, injury, surgeries if none fill in with N/A

How does your disability limit your daily life?

Any other limitations we need to be aware of, such as mobility, vision, hot/cold sensitivities, balance, etc, if none fill in with N/A

Handler's Daily Routine

Do you organize and take your routine medications by yourself or do you require assistance?

Self
Require Help

Do you do your own housecleaning?

Self
Require Help

Do you cook for yourself?

Self
Require Help

Do you dress yourself?

Self
Require Help

Do you do your own personal care or require assistance?

Self
Require Help

Do you drive yourself?

Self
Require Help

Do you have history of drug or alcohol use and/or abuse?

Yes
No

How do you think a Service Dog will assist you in your daily life style?

Does everyone in your household support the idea of you having a Service Dog?

Yes
No

Have you owned a Service Dog in the past?

Yes
No

Have you ever been accepted into another Service Dog program?

Yes
No

Have you ever been denied from a Service Dog program?

Yes
No

Cost of Service Dog

Please remember that having any dog, Service or pet, is a personal commitment. Service Dogs carry serious financial responsibility, estimated at $2,000 per year. This amount takes into consideration veterinarian expenses, preventative medications, food, and in some cases professional grooming and specialized working gear. We strongly encourage handlers to invest in pet insurance to ensure you have a monetary options and care in case of unforeseen medical emergencies. The Duncan School and any staff of the company is not responsible for covering medical care, treatment and gear.

Do you have the financial resources for the proper care of the Service Dog?

This includes veterinarian care and monthly heartworm and flea/tick preventative medications.

Yes
No

Legal History

Please be truthful and honest in this section, a "Yes" answer doesn't necessarily disqualify you from the program.

Have you ever been convicted or charged with a felony?

Yes
No

Have you been charged with or convicted of a misdemeanor?

Yes
No

Have you ever been charged with or convicted of any criminal traffic violations?

Yes
No

Have you received other traffic vilations?

Yes
No

Have you ever been arrested?

Yes
No

Do you have a history of violence?

Yes
No

Have you ever become so angry/frustrated that you have hit someone?

Yes
No

Have you ever become so angry/frustrated that you have hit an animal?

Yes
No

Agreement

By signing below, I give consent to The Duncan School Service Dog Program's staff to discuss needs in a professional and discrete manner to better assist me in this journey. I understand that the information is confidential, will not be released to any person or agency outside of the program, and will be used for the sole purpose of assessing my qualifications for a service dog and to provide a suitable home for a service dog.

Signature

Date

Upload Doctor's Letter verifying the assistance of a Service Dog could help mitigate the handler's diagnosis

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Vet Record Upload

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Upload Headshot

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our Service Dog Application: We're One Step Closer!

Thank you so much for taking the courageous step of applying for The Duncan School's Service Dog Program. We understand that you're seeking a path to greater independence and support, and we're truly honored that you've chosen us to be part of your journey.

You're the hero of this story, and you're facing the challenge of navigating life with specific needs. We're here to be your trusted guide, helping you find the perfect canine partner to empower your independence.

Your application has been received and is now being carefully reviewed by our team. We know you're eager to move forward, and we're committed to providing you with a timely response.

You can expect to hear from us within 3-5 business days with the next steps in the application process. We'll be in touch to discuss your application in detail and answer any questions you may have.

In the meantime, feel free to explore our website at theduncanschool.com for more information about our program and the incredible impact service dogs can have.

We're excited about the possibility of working with you and helping you build a life-changing partnership.

Warmly,

The Team at The Duncan School

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