Service Dogs, Inc. Facility Dog Pre-Application Questionnaire

Facility Dog Pre-Application Questionnaire

Date

What type of Facility Dog do you need?*

Courthouse Facility Dog
First Responder Facility Dog

If you chose "other" above, please explain.

Name*

First Last

Home Address of the Agency's Handler*

Street Address City State / Province / Region ZIP / Postal Code

Cell Phone*

Work Phone*

Work Email*

Alternate Email*

Please list each person the handler lives with: Name,relationship to you. It is important that each person in your home be comfortable with and accept the dog.*

Please list the breed and age of any pets in your home.*

Agency's Facility

Please provide the name, title and contact information of the supervisor or other representative at your agency's facility who has given approval for you to serve as the handler of the agency's Facility Dog.

Name of your agency's facility*

Facility Address (where the Facility Dog would primarily be working)*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Facility Website

Main Phone Number of Facility

Your job title and description*

Name of Supervisor or Representative*

Prefix First Last Suffix

Address of Agency's Facility Supervisor

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone of Supervisor*

Email of Supervisor*

Role of Facility Dog*

Please describe in detail what you want the Facility Dog to do at your agency's facility. Include whether you want the Facility Dog to work in other places in your community and beyond.

Description of agency's facility and other environments where the dog will work, e.g. office building, medical facility, school, community locations, out of town locations)

Schedule - Describe the schedule the dog will be working. Include how many hours a day you expect the dog to be working/on call.

Public access - Facility Dogs do not have public access like Service Dogs do. Facility Dogs must have the permission of a business, restaurant, store, etc. and public transportation in order to enter. Where will the Facility Dog accompany you besides your workplace?

Will you be able to attend Applicant Orientation (1 day), Matching (2 hours) and Team Training (5 days) at the SDI training facility in Dripping Springs, Texas?*

Yes
No

Are you willing to wait 6 months to 2 years for a Facility Dog?*

Yes
No

Is your agency committed to $2,000 annually for the Facility Dog's care? (premium dog food, veterinary visits, heartworm and flea preventatives)*

Yes
No

Changing Jobs

Changing Your Job - If you leave or change your job, SDI requires a written plan for the Facility Dog. This must be reviewed and signed by your supervisor and then submitted to SDI for approval. Do you commit to providing SDI with such a plan?*

Yes
No

New Handler - If you leave your job, who do you anticipate will be the Facility Dog's new handler and caretaker?

Supervisor - Who do you anticipate will be the Supervisor managing the dog's reassignment?

New Handler Application - Does your agency agree to have the proposed new handler go through the SDI Application process?*

Yes
No

Does your agency commit to sending the new handler to SDI for Team Training and to participate in In-Home Training in the new handler's home and workplace?

Yes
No

Facility Dog Pre-Application Questionnaire

Facility Dog

(Includes Courthouse Facility Dogs, First Responder Facility Dogs)

Facility Dog Pre-Application Questionnaire

Agency's Facility

Changing Jobs