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.

(The client application is currently unavailable for download. Please contact ADW at info@assistancedogsofthewest.org for an application. We apologize for the inconvenience and will have the forms back up online soon.)

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

Client Fee Increase Notice:

Please be advised of a change in the cost of client services from Assistance Dogs of the West.

Due to the extreme financial strain placed upon our agency from the economy and the real costs attached to the entire process, the ADW Board and management has determined that we must raise the client fees for services attached to the placement of an assistance dog.

As of September 1, 2010, the fee for New Mexico State residents will be $5,000 and the fee for out of state residents will be $7,500. These fees cover the costs attached to the application/interview/placement training and follow up activities.

ADW will continue to support client fund raising efforts and is at your disposal to answer any questions and supply you with any ADW materials or information to simplify that process.

If you complete the client portion of the application and your application is received in our office prior to September 1, 2010, the $3,500 NM State Client Fee/$5,000 out of state Client Fee will be honored. Any application received after that date will be subject to the new client fees.

If you have any questions, please do not hesitate to contact our office.