Application for Veterans and Service Members

Application for Veterans and Service Members

Thank you so much for your interest in our Pups4Patriots™ program! We appreciate your interest and look forward to the possibility of matching you with a service dog. To qualify, you must:
- Be a military veteran
- Have a service-related post-traumatic stress disorder (PTSD) and/or a traumatic brain injury (TBI) diagnosis from a mental health professional
- Be participating in regular mental health treatment (your clinician will need to submit a form)
Please note: We don't provide guide dogs, hearing dogs, or mobility dogs.
Basic Information
Name *

First Name Last Name
Email *
example@example.com
Phone Number *

Area Code Phone Number
Address *

Street Address

Street Address Line 2

City State

Zip Code
Date of Birth *

Month Day Year
Date
Gender *
Current Employer
Type NA if not applicable
Military Service
Branch *
Rank *
Type of Discharge *
Please list the dates and locations of your combat deployment(s)? *
Date - Deployment location
Questions
Have you been diagnosed with service-related PTSD and/or TBI by a healthcare professional? *

Yes No
Are you currently receiving mental health treatment for PTS/TBI? *

Yes No
Have you ever been denied a service dog through another organization? *

Yes No
Is there anyone else living in your home? *

Yes No
If yes, please list each household member’s age and relationship to you *
Example: Daughter (10)
If yes, please specify
If there are children living in your home, please write down their age
Do you have a pet dog or other animal at home? *

Yes No
If yes, please specify *
Also write down their type, age and breed
Are you or anyone else in your home allergic to dogs? *

Yes No
Are you able to financially support the care of a service dog over the course of their lifetime? (We estimate the cost of a service dog to be approximately $2,000 per year) *

Yes No
Please provide us with an explanation of why you believe a service dog will help your symptoms and improve your quality of life day-to-day: *
Please note: We don't provide guide dogs, hearing dogs, or mobility dogs
How did you hear about us? *
If you have any questions or concerns about this application, please email infomilitaryaffairs@americanhumane.org.
Should be Empty:

Basic Information

Military Service

Questions