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Emotional Support Animal Application
ESA Application
"
*
" indicates required fields
1
About You
2
Applicant Background & History
3
Military History
4
Document Uploads
5
Statements of Understanding
6
Name
This field is for validation purposes and should be left unchanged.
About You
Name
*
First
Last
Phone
*
Email Address
*
Email Address
Confirm Email Address
Do you live in Southern California?
*
Our facility is based in North County San Diego. Students are required to complete up to 10 one-hour private sessions or until the student and dog pass the AKC Canine Good Citizen test.
Yes
No
We are currently only serving those within the Southern California region. Please email veteranservices@sheltertosoldier.org for assistance regarding similar programs in your area.
Where are you located?
*
City
State / Province / Region
ZIP / Postal Code
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.
White/Caucasian
Asian or Pacific Islander
Hispanic/Latino
Native American
Multi-racial/Multi-ethnic (2 or more races or ethnicities)
How do you publicly self-identify?
*
We utilize this information to monitor and analyze the demographic profile of individuals benefiting from our program.
Heterosexual or Straight
Gay, Lesbian, or Bisexual (or other sexual orientations within the LGBTQIA+ community)
Different Identity
Decline to State
How do you publicly self-identify?
*
We utilize this information to monitor and analyze the demographic profile of individuals benefiting from our program.
Female
Male
Gender Nonbinary/Gender Queer/Gender Nonconforming
Decline to State
Other
Do you understand that you are applying for a Shelter to Soldier Emotional Support Dog™ and not a task-trained service dog?
*
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). If you are in need of a service dog, please visit our service dog application.
Yes
Lifestyle
List the ages and relationships for everyone living in your household
*
Do you have any other pets at home (please list the species, age, gender, breed, etc)?
*
Are you currently in school?
*
Are you currently employed?
*
If so, what is your work environment and schedule?
Do you have your own reliable transportation?
*
What type of activities would you like to do with your dog?
*
Background Questions
How did you hear about Shelter to Soldier?
*
Radio (91X)
Community Event/Resource Fair
Social Media (Newsletter, Instagram, Facebook, Tik Tok)
Department of Veteran Affairs
Family Member or Friend
Has anyone ever taken an animal away from you due to negligence or because of an abuse claim?
*
Yes
No
If yes, please explain:
Have you ever rehomed a dog?
*
Yes
No
If yes, please explain:
Have you ever been convicted of a felony?
*
Yes
No
If yes, please explain:
Have you ever been convicted of a misdemeanor?
*
Yes
No
If yes, please explain:
Have you been arrested for anything in the past 24 months?
*
Yes
No
If yes, please explain:
Have you ever been so angry you struck a person, thrown an object at someone or broken personal property?
*
Yes
No
If yes, please explain
Are you or anyone else in your home allergic to dogs?
*
Yes
No
Do you understand you will need to send a video of your home ?
*
Our Board of Directors will review the home video to ensure the environment is safe.
Yes
No
Service History
Please select the category that best describes your service or affiliation
United States Military Veteran
Active-Duty Military
National Guard/Reserves
Gold Star Family Member
First Responder
Required Documents
Proof of Service
*
Military personnel may submit the following redacted: LES or orders First responders may submit the following: a redacted pay stub and or a letter from your employer
Max. file size: 50 MB.
ID
*
This can be a state-issued ID or valid driver’s license.
Max. file size: 50 MB.
Letter of Support from a Family Member or Friend
*
The letter should reflect a personal introduction stating the writer's relationship with you, highlighting positive qualities and specific examples of your character, and expressing strong support for your application for an emotional support animal.
Max. file size: 50 MB.
Proof of Housing
*
Must be either a mortgage, rental, lease agreement, or utility bill.
Max. file size: 50 MB.
Statements of Understanding
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 applicant's home must be evaluated by a Shelter to Soldier trainer before the applicant's submission to the board of directors, to confirm that the pet dog will be compatible with a Shelter to Soldier dog. If the applicant’s pet dog(s) are not deemed socially or behaviorally appropriate to reside with a Shelter to Soldier 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, approved 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 approved students 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 agree to the privacy policy.
Truthfulness Acknowledgment
*
By checking this box, I agree that I understand the forelisted consequences that may occur, as result of providing false, untrue, misleading, or misrepresenting statements or claims.
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