This application is for a companion dog.  While companion dogs have learned their basic obedience skills and "house manners," companion dogs do not have the advanced skills of a full service dog. Additionally, the companion dog team is not afforded the rights of public access under the American with Disabilities Act, as is the full service dog team. 

 What you should know before you apply…

·        We will not train your personal pet to be your service dog.

·        If selected to receive a dog from Promising Partners, we ask that you pay a $250 placement fee.

·        Applying for a dog now does not mean you will have it tomorrow.  Finding the right dog for you is an important process and you should expect the process to take no less than 6 months.  (To date 11/30/2006 we are just starting to take in our puppies in training which means we expect our first placements to take place around 1 1/2 –2 years from now.)

After we receive your completed application we will meet with you for an interview.

IF you receive a companion dog from Promising Partners you will be required to complete a written report every six months, keep veterinary care current, and ensure the dog is in a loving and caring environment.

Thank you again for your interest. Please feel free to call us at 620-564-2993 if you have any questions. 

Please initial when read_____________

Name: 

Date:

Address:

Age:

Phone: (H)

(W) 

Email:

Birthdate: 

SS#:

Please list current grade and school or current occupation & employer:

Do you have a disability? 

Please describe and add age of onset.

Do you currently own and operate a motor vehicle?

Do you have any pets? 

Please list type, breed and ages:

Please list all the people residing in your home and their ages:

Do you own or rent your home? 
If rent, do you have a pet policy?
Include copy of policy or letter from landlord.

Do you have any experience working with animals? 
If yes please explain:

In order to select an appropriate canine companion for you we ask that you complete the following questions with as much information as you feel is necessary for us to get to know you.

Please describe your home/family and general schedule:

Do you have a fenced in yard? 

If no, are you willing to always walk the dog on a leash? 

Approximately what percentage of the day are you away from home?

Do you travel? 

Where and how often?

Who Referred you to Promising Partners?

Please have a local vet of your choice send us a letter saying that they will be caring for the dog’s health and will cooperate with Promising Partners follow up when we ask for the dog’s records. We will make arrangements to have the dog’s health history sent to your vet. (This letter does not need to be sent with the application but will be necessary before proceeding with the process beyond the initial interview.)

Please Complete Essays on a
 Separate Piece of Paper

This essay should be written by the applicant, if that is not possible it should be written in his or her own words. 

Description of Recipient Essay:

The purpose of this essay is to enable Promising Partners to understand your physical traits, lifestyle, disability, activities and personality. Through a detailed description of yourself, your home, your family and your activities, we can better establish the type of dog most suited for you. Also describe how you feel a home companion dog would be beneficial to you and how you see yourself caring and giving back to the dog. Please be as precise and comprehensive as possible!

Please read the following paragraph carefully:

I understand the term "companion dog" refers to a dog that has been trained in basic obedience skills and that while the companion dog has learned "house manners", he/she has not received the more advanced training of a full service dog. Unlike the full service dog/recipient team, in accordance with the Americans With Disabilities Act, the companion/recipient team does not have public access rights. Under no circumstances is the companion dog allowed to go into any public facility where pets are not routinely allowed unless given special permission. In no way is the companion dog to be represented as a full service dog.

Please have all adults residing in household sign below to acknowledge that each understands the term "companion dog", and understands and agrees to follow the public access guidelines as noted above.

Name 

Date

Print out, complete and return questionnaire to:

Promising Partners Assistance Dogs, Inc., P.O. Box 364, Ellinwood, KS 67526.