ADW Eligibility Questionnaire

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Home
MEET THE PUPPIES
- Puppy Cam
Support a Pup
- Your Donations
Who We Serve
Connect with ADW
Guest Book
Purchase Classes

Please note ADW is located in Santa Fe, New Mexico. Our dog matching process requires clients to come to our Santa Fe facility for Dog Interviews and Client Placement Training. You may need to make multiple trips to ADW in order for us to identify your canine partner. Because many out-of-state clients do manage geographic challenges, we say this not to be discouraging, but to be fully transparent.

TELL US ABOUT YOURSELF

To provide ADW adequate time to carefully assess your needs, there is a minimum two week response time.
Your patience is greatly appreciated as we review this information.

* Indicates required field

Name *

First

Last

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Email *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Have you been diagnosed with a disability as defined by the ADA? *

Yes No

If yes, please list Primary Diagnosis. If no, enter N/A:: *

If yes, please list Secondary Diagnosis. If no, enter N/A *

Best number to reach you *

Please describe your living situation *

Alone Group Home With Family Roommate On Military Base

Are you a veteran or active military? *

Yes No

Height *

Age *

Please list your needs. *

Please list 3 tasks you hope a dog will do for you. *

Would this dog be for yourself or someone else? *

Myself Someone else

If someone else, please describe them, including their age: *

What type of assistance dog are you looking for? *

Please choose one *

I want an ADW dog I need ADW to help me train my dog

If you have applied to other service dog agencies, please list here. If not, enter N/A: *

Please estimate in dollars the annual cost of maintaining the health of a dog. *

How much time can you devote to the care of your dog? *

Do you have the financial capabilities to travel to Santa Fe, NM multiple times? *

Yes No

Submit

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Assistance Dogs of the West is a 501(c)(3) tax-exempt organization.

Please note: If ADW has received sufficient funds to cover a specific donation category within a fiscal year, your donation will be used where it is needed most.