the forms

ADW Client Forms

Thank you for your interest in a service dog from Assistance Dogs of the West.

A COMPLETE APPLICATION PROCESS WILL INCLUDE ALL OF THE FOLLOWING:

1. Completed Program Application Form
2. Completed Pre-Interview Form
3. Medical History Form completed by your physician or primary care specialist
4. A letter of personal reference from a friend, co-worker, or someone other than a family member.
5. A professional letter of reference from a therapist, social worker, teacher, or other professional with whom you have contact.
6. A picture of you, your family/living environment and a short autobiography.
7. Completed Financial Aid Form
8. A signed copy of ADW’s Privacy Practices
9. An appointment for a Functional Evaluation with our occupational therapist.
10. Appointments with ADW staff for personal and home interviews.

Once we receive a completed application, you will be advised to make an appointment for a Functional Evaluation with our Occupational Therapist. Next you will set an appointment with an ADW trainer to help us understand your needs, personality, and lifestyle in order to match you with the right dog. The third step in the process is a home visit during which ADW staff will assess your environment for suitability in working with a service dog. All of this information is used to conduct a staff review to determine whether the applicant meets the profile for a successful placement candidate with an ADW dog.

When applicants are notified of acceptance into the ADW program, the final step is the waiting list. Although the ADW waiting list is shorter than most service dog organizations, it averages six months to two years to make a client/dog match. Client/dog interviews are conducted on a regular basis during this time to assess needs and potential matches. Occasionally new information identified during the interview process can change client acceptance status if a need is found that ADW dogs cannot meet. Once a match is made, the client is then scheduled for the next two week Client Placement Training (CPT) in Santa Fe. A minimum one half of the $5,000 in-state / $7,500 out-of-state client fee is due the first day of CPT. ADW can help with information about government funding, grants, scholarships, fund raising ideas and other financial support.

Clients interested in diabetic alert (both Owner/Self-Training and ADW Assistance Dog interest) MUST be on an insulin pump and acclimated to that pump for no less than 6 months. The reason for this is for more accurate readings of blood sugar highs and lows, tracking the dog’s work, and the client’s ability to maintain and monitor their own blood glucose levels. Clients should anticipate weekly training sessions in Santa Fe, New Mexico for the duration of the placement process (which may last upward of a year).

Click Here to Download Application Packet.

If you have any questions about our application or process, please contact the ADW office at (505) 986-9748 or e-mail us at info@assistancedogsofthewest.org