Application

Please use this form if you are applying for financial assistance, requesting an evaluation, scheduling a board and train, or are requesting to be a student in our program.

Personal Information

All applicants must be age 21 or older

First name

Last name

Preferred Name

Birthday

Month

Day

Year

Address

Phone

References

Please provide three references we may contact. References must be the age of 21 or older

First and Last Name

Phone

Address

First and Last Name

Phone

Address

First and Last Name

Phone

Address

Dog Information

Dog Name

Dog Breed

Dog Age

Requirements and Expectations

Have you ever had a Service Dog previously?

Yes

What are you wanting your Service Dog to be trained to do for you?

If you are unable to care for your service dog at any time do you have someone set up as an emergency contact who can care for them until you can?

Yes

Emergency Contact First and Last Name

Phone

Address

Transportation

Do you have reliable Transportation to attend weekly training sessions for a period of ten to twelve months?

Yes

Do you have reliable Transportation to get out into public and practice homework two or three times a week?

Yes

It is required that you attend three public access outings with Central Ohio Service Dogs during your training time to be eligible for graduation. They may be held on weekdays, evenings, or weekends. Can you commit to a minimum of three outin

Yes

We require a minimum of five volunteer hours where you will be required to volunteer in one of the needed areas before being eligible for graduation. Can you commit to this obligation if you are accepted into our program?

Yes

Monthly Expenses Budget

Please fill out below your planned budget and expenses that you are prepared to offer to care for your dog. Please include an amount for an emergency fund should an emergency with your dog come up.

Food (Victor High Pro Plus)

Flea and Heartworm Protection

Routine Wellness Visit (Annual Averaged)

Deworming

Gas for Monthly Training Trip

Monthly Emergency Fund

Total Monthly Budget

I have read and agree to Central Ohio Service Dogs' Policies and Liability Documents

Return and Refund Policy

Many variables determine the potential success of this program including the owner's ability and effort; the dog's learning capacity, temperament, and ability to perform, the specific needs of the owner and many other unknowns. As such, the successful performance of any owner trained service dog cannot be guaranteed by COSD. No refunds, returns, or exchanges will be made on any monies sent to COSD for applications, training, evaluation or testing purposes. Sessions unused must be used within 12 months or they will go into our Scholarship Fund. If your training was fully funded and you graduate early the remaining sessions will be donated to another student and handler team in need. Any chargebacks we receive filed by you will incur a fee of up to 25% of the total the chargeback was filed for. There may be additional lawyer, court, and filing fees that apply.