Apply - Shelter to Soldier™

1Basic Info

2Home Info

3Military Service

4Medical Info

5Documentation

6Veteran Pet Policy

7Confirmation

Name*

First Last

Phone*

Email*

Date of Birth*

MM slash DD slash YYYY

What is your race or ethnicity?*

We utilize this information to monitor and analyze the demographic profile of individuals benefiting from our program.

How do you publicly self-identify?*

We utilize this information to monitor and analyze the demographic profile of individuals benefiting from our program.

How do you publicly self-identify?*

We utilize this information to monitor and analyze the demographic profile of individuals benefiting from our program.

Do you live in Southern California*

Our facility is based in North County San Diego. Students are required to visit the facility once a week for an estimated period of 6-9 months to complete psychiatric service dog program For the emotional support animal program, students are required to complete up to 10 weekly lessons. Follow up lessons post-graduation are also required at the facility.

Yes

Are you applying for Shelter to Soldier Psychiatric Service Dog™, or a Shelter to Soldier Emotional Support Dog™?*

A psychiatric service dog is individually trained to do work or perform tasks for the benefit of an individual with psychiatric, intellectual, or other mental disability.

An emotional support dog can provide comfort, companionship, and relieve loneliness but are not trained to perform specific tasks for their handler. Emotional support dogs are not permitted in public establishments (i.e., restaurants, stores, or in VA facilities).

Shelter to Soldier Psychiatric Service Dog™

Shelter to Soldier Emotional Support Dog™

How did you hear about Shelter to Soldier?

Has anyone ever taken an animal away from you due to negligence or because of an abuse claim?*

Yes

If yes, please explain:

Have you ever rehomed a dog?*

Yes

If yes, please explain:

Have you ever been convicted of a felony?*

Yes

If yes, please explain:

Have you ever been convicted of a misdemeanor?*

Yes

If yes, please explain:

Have you been arrested for anything in the past 24 months?*

Yes

If yes, what was the reason for it?

Have you ever been so angry you struck a person, thrown an object at someone or broken personal property?*

Yes

If yes, please explain:

Are you currently employed?*

Yes

If yes, how many hours a week do you normally work?

If yes, what type of work do you do; and what type of environment are you in, while at work?

Are you currently a student in a college or trade school?*

Yes

Please share any post-military service educational degrees and achievements?

City*

District*

If you reside in San Diego County, which county district do you reside in? If you do not reside in San Diego County, please identify which county you reside in.

State*

Zipcode*

Do you have any plans to move out of Southern California?*

Yes

If yes, when do you plan on leaving the area?

Do you have any pets at home?*

Yes

If yes, please list your pets and the type of pet they are.

If no, have you ever had a dog before?*

Yes

Please list the names of people living with you, their ages, and their relationship to you.*

Are you or anyone else in your home allergic to dogs?*

Yes

Have you ever been denied a service dog through another organization?*

Yes

Please provide the date, organization and reason provided*

Do you understand that if approved, a home inspection may be conducted and do you agree to a home inspection?*

Yes

We understand this is personal information and may be very difficult to share. Please understand that all information shared on this application is confidential, handled with care and is intended to help you gain acceptance to our program. The information also assists us in getting to know you, your personal needs and if accepted, the details will assist us in matching you with a dog that will be the right fit for you. The more we know about you and your time in the service, the better our team can best understand how to assist you.

Branch of Service?*

Are you currently Active Duty?*

Yes

Are you currently in Reserve Status?*

Yes

Are you Medically Retired?*

Yes

Are you a Veteran of the Gulf War?*

Yes

Are you a Post-9/11 Veteran?*

Yes

Are you a MST (military sexual trauma) survivor?*

Yes

What is your DD-214 discharge status (Honorable/Other than Honorable/Dishonorable)*

Please list dates and locations of your deployments.*

Please share with us some background information about your time in the military, and what led to your need for a service dog.*

You understand that any and all medical information you choose to provide, is done so on a voluntary basis. You providing information and/or documentation regarding your medical, and/or mental health diagnosis’, is used solely for the purpose of assessing your needs, and how a service dog could potentially assist you.

What is your primary diagnosed disability; and what is your percentage of disability awarded by the Department of Veteran Affairs?*

Do you currently have a mental-health care provider?*

Yes

If “Yes”, please enter their information.

If “No”, would you be willing to establish care with a mental-health care provider?*

Yes

Is your primary disability service-connected?*

Yes

Has a medical professional recommended that a service dog will be of benefit to you and your primary diagnosis?*

Yes

Please list any other diagnosis that you would like to share with us?

Please tell us why you believe a service dog will help with your symptoms and improve your quality of life day-to-day?*

DD214*

Please redact your social security number. If you are applying for an Emotional Support Animal and not a Service Dog, you may upload proof of service if still active duty.

Drop files here or

Max. file size: 50 MB.

Proof of Housing*

Can be a mortgage, rental, or lease agreement.

Drop files here or

Max. file size: 50 MB.

VA Rating

This must reflect a diagnosis. We will not accept a benefit summary letter. If you are applying for an Emotional Support Animal instead of a Service Dog, you can skip this upload.

Drop files here or

Max. file size: 50 MB.

ID*

This can be a state-issued ID or valid driver’s license.

Drop files here or

Max. file size: 50 MB.

Letter of Support from a Family Member or Friend*

Drop files here or

Max. file size: 50 MB.

Veteran Pet Policy*

All applicants must disclose any and all pets living in their home, along with their living arrangements, during the application process. All pet dogs already residing in the veteran’s home must be evaluated by a Shelter to Soldier trainer prior to submission of the veteran’s application to the board of directors, to confirm that the pet dog will be compatible with a service dog. If the applicant’s pet dog(s) are not deemed socially or behaviorally appropriate to reside with a service dog, the applicant will have the choice to withdraw their application, permanently re-home their pet dog, or pursue training of the pet dog to address behavior issues (in which case the dog would need to be re-evaluated following training). Additionally, Veteran Students are not permitted to adopt any new pet into their household during the training program, and for 6 months following their graduation from the program. It is recommended that Veteran Recipients consult the Shelter to Soldier training team prior to adding any future pets to their household, as an inappropriate dynamic can be detrimental to the overall success of the service dog in their role. Signing below acknowledges that you have read, understand, and accept the above policy.

I have read, understand, and accept the above policy.

I hereby declare that the details provided above are true and correct to the best of my knowledge and belief. Furthermore, I agree to inform you of any changes therein, immediately.

In any case whereby the above information I have provided is found to be false, untrue, misleading, or misrepresenting, I am aware my approval by the Shelter to Soldier Board of Directors, may be RETRACTED, resulting in an immediate and permanent dismissal of ANY programs or services offered by Shelter to Soldier, or any affiliate companies.

In any case whereby the above information I have provided is found to be false, untrue, misleading, or misrepresenting, I am aware any established training program with Shelter to Soldier may be terminated, without any sort of compensation.

By checking this box, you agree that you understand the forelisted consequences that may occur, as result of providing false, untrue, misleading, or misrepresenting statements or claims.

Phone

This field is for validation purposes and should be left unchanged.