Apply for a Guide Dog

Applicants must be legally blind and can demonstrate the need for a guide dog to help them remain safe and effective in their everyday travel. We look for clients that can independently travel practical and purposeful routes with their current mobility device.

This online application is part one of our application process. Once you have submitted the application below, a member of our team will contact you within five business days. All fields are "Required" before you can submit the application.

As you proceed through our application process, we will require additional documents, including a medical report to be completed by your physician, an Orientation and Mobility Specialist’s report, an ophthalmology report, and application video. Click here to see our guide to create your application video. Please note that the completion of the following application form does not guarantee acceptance as a client at the Guide Dog Foundation.

All information provided is privileged and will be considered confidential. The Foundation administers its employment, admissions and training programs in a nondiscriminatory manner and in accordance with applicable state and federal laws.

Is a Guide Dog Right for Me?

The decision to get a guide dog is a momentous one. We’ve prepared a short guide to help you answer the question. Click here for PDF or here to download text only.
For an overview of the guide dog training program click here.
To learn more about program admission, click here.

The Foundation does not discriminate on the basis of sex, age, race, color, national origin, citizenship status, creed, religious affiliation, marital status, sexual orientation, gender identity or expression, victims of domestic violence or the presence of a medical condition or disability, predisposing genetic characteristics, or any other group protected by law.

For Screen Reader Users:

The application below includes a number of fields. You will be required to use the "Tab" button, "Arrow" keys or other keys specific to your screen reader in order to navigate through the application.

Once you submit your application, you should be directed to a message that verifies that we have received your application. If you are not directed to that page, you will be re-directed to the top of the application where you will find a list of fields that must be completed before you will be able to submit your application.

If you cannot navigate the form, or your browser does not support forms, please contact Consumer Services for assistance at ConsumerServices@GuideDog.org or call (866) 282-8047. A Word Document application is available by request.

PERSONAL INFORMATION

First Name (Legal Name) *Required First Name Required

Last Name *Required Last Name Required

Home Street Address 1 *Required Home Street Address Required

Home Street Address 2

City *Required City Required

State/Province *Required State Province Required

Zip code/Postal Code*Required Postal Code Required

County

Country (Click first letter for shortcut -leave blank for United States)

Home Phone (Include area code) *Required Home Phone Required

Cell Phone (Include area code)

Email *Required Email

Date of Birth (MM/DD/YYYY) *Required

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BirthDate Required
Gender

Height *Required Height Required

Weight *Required Weight Required

For statistical purposes, what is your ethnic background?

Are you legally blind?

Year of vision loss (Enter four digit year) *Required Year of vision loss Required

Cause of blindness *Required Cause of blindness Required

Amount of vision *Required Amount of vision Required

Do you have hearing loss? *Required Do you have hearing loss Required

If so, what degree of loss?

Other physical disabilities

Please describe how your disability affects your life, and your current level of independence.

Are you a veteran? *Required Veteran Required

If yes, what branch of service?

If yes, what campaign did you serve?

Were you honorably discharged?

If discharged, please provide a copy of your DD-214 (Member-4) by sending a copy to: Richard.Helling@vetdogs.org, Fax: 631-930-9075 or mail: America’s VetDogs Consumer Services, 371 E. Jericho Tpke. Smithtown, NY 11787.

I am interested in the CATs and Dogs program. (In partnership with the Cleveland, Biloxi and Waco VA Blind Rehabilitation Centers, America's VetDogs offers a 10-day inpatient CATs and Dogs program designed to provide veterans who are blind or visually impaired with guide dog training while the VA assists with Computer Access Training (CAT).)"

Are you currently employed? *Required Are you currently employed Required

If yes, what is your present occupation?

Have you ever had a drug or alcohol abuse problem? *Required Drug or alcohol problem Required

Have you ever been convicted of a felony? *Required Felony Yes or No Required
If yes, please provide details

Are you currently seeing any of the following specialists? *Required (Please check all that apply.)

Cardiologist

Endocrinologist

Mental Health Professional/Therapist/Counselor

No other specialists

Other

Psychiatrist

Have you had mobility instruction? *Required Mobility Yes or No Required

If so, when? (Enter four digit year)

What type of mobility aid do you use primarily? *Required Type of mobility aid Required

Do you cross streets without assistance from other people? *Required Cross streets without assistance Required

Do you currently have, or have you had a guide dog before? *Required Current or Past Guidedog Required

If yes, from where?

Other school

On average, how many blocks do you independently walk each day?

Please list up to 3 destinations that you independently walk on a regular basis. Please list the mailing address if available. *Required
Destination 1 Destination 1 Required
Destination 2 Destination 2 Required
Destination 3 Destination 3 Required

Determining factor in your decision to apply? *Required Decision to apply Required

Correspondence Preference

Above statements have been truthfully answered *Required Answered truthfully Required

CONSENT TO RELEASE - Use your "Arrow" keys to navigate and read the information below. This Consent section of the form must be signed below.

This authorization shall become effective immediately and shall remain in effect for a three-year period from the date it was signed. This is to authorize any physician, hospital, firm, organization or person to furnish to the Guide Dog Foundation for the Blind, Inc. and America's VetDogs - the Veteran's K-9 Corps (hereinafter referred to as "GDF & AVD"), all information, material or opinions that may be requested by GDF & AVD concerning me. GDF & AVD are further authorized to copy any records pertaining to me. I hereby waive any privilege I have to said information to GDF & AVD, and agree to hold GDF & AVD blameless from any claims as a result of the sharing of information related to me.

The Information received by GDF & AVD, will only be used to evaluate my application for a guide or service dog and training in the use thereof.

I understand that any information provided to GDF & AVD will remain confidential.

I understand that my failure to disclose any medical or personal information that pertains to my ability to work with an assistance dog may result in the denial of my application or termination of training.

By clicking “Submit” with my name typed below, I agree to submit this application, which includes the Foundation Code of Conduct and the Consent to Release form, by electronic means and adopt such process with the intent to sign this form.

Please type your full name and this will serve as your signature.

Applicant's name/parent guardian if applicable *Required Consent to Release Required

Date (MM/DD/YYYY) *Required

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Consent to Release Date Required

If it is determined that you are qualified to participate in our guide dog training program, you will be invited to continue with Part two of the application, which includes a medical report, O&M report, ophthalmology report, and application video. Would you prefer these forms be sent to you by mail or electronically?

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Guide Dog Application_old

Apply for a Guide Dog

Is a Guide Dog Right for Me?

For Screen Reader Users:

PERSONAL INFORMATION

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