Application Need a Battle Buddy? Please fill out the application below. Please Fill Out The Form Below! Name* First Middle Last Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* DOB* MM slash DD slash YYYY Gender F M Non-Binary Emergency Contact Name Emergency Contact Number Marital StatusSelectMarriedSingleWidowedDivorcedSeparatedHow Many People Live in Your Household Are you currently workingSelectYesNoAre you enrolled in SchoolSelectYesNoDo you have a caretaker Is anyone in your home allergic to dogsSelectYesNoDo you have petsSelectYesNoIf Yes, are they all up to date with vaccinationsSelectYesNoLiving ConditionsHouseApartmentCondoTrailer HomeOtherOther Own or Rent?RentOwnIf you were to become hospitalized, who would care for your service dog Are you able to feed, walk and groom the service animal MEDICAL INFORMATIONHave you been diagnosed with Post Traumatic Stress*SelectYesNoHave you ever been diagnosed with Traumatic Brain InjurySelectYesNoAre you a Survivor of Sexual of Military Sexual Injury/TraumaSelectYesNoName of the Medical Center/Physician that determined the diagnosis Address of Center/Physician Harming Yourself?SelectYesNoHarming An Animal?SelectYesNoViolent with othersSelectYesNoPlease provide 3 personal references and their phone numbers. One of which may not be a relative or someone living with you.Name Number Name Number Name Number Military Service Information.Branch of Service* Entered Active Service Date MM slash DD slash YYYY Discharge Date MM slash DD slash YYYY Entered Active Service MOS/Rate Discharge MOS/Rate I hereby agree to the following statement: V.E.T. Service Dogs NFP has authority and permission to contact any person you have referenced on this form.Signature* Date MM slash DD slash YYYY Please submit a copy of a signed letter from a doctor, psychiatrist, psychologist or therapist that has diagnosed your condition of PTSI, TBI, MSI. You can also supply a rating from V.A Please scan and submit a copy of your D.D. 214, and please block out social security numberUpload Files Drop files here or Select files Max. file size: 100 MB. Additional Information NameThis field is for validation purposes and should be left unchanged. Δ If you would like any assistance, please call us directly at (708) 274-7678