Therapy Dog Program Interest

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Please complete the form below if you are interested in learning more to request an application.

I'm seeking

Therapy dog certification with my Canine Companions dog.To adopt a dog through the Canine Companions programA Therapy Dog Evaluator ApplicationI am seeking a service or facility dog.

Canine Companions Dog's Name

Are you a current breeder caretaker and applying with your current breeder dog?

YesNo

Canine Companions

You may use this link to find out more about our service or facility dogs.

Applicant

First Name

Last Name

Birth Date

Preferred Pronoun

If you have preferred pronouns that you would like us to use as we work together in the application process, please share them with us.

Personal Email

Preferred Phone Number

Preferred Phone Type

Secondary Phone

Secondary Phone Type

Address Information

Mailing Street

Mailing City

Mailing State

Mailing Zip

County

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Therapy Dog Evaluator

Why do you want to be a Canine Companions for Independence volunteer therapy dog evaluator?

What interests, skills or background do you have related to therapy dog work?

Therapy Dog Handler

Why do you want to become a certified Canine Companions therapy dog handler?

What interests, skills or background do you have related to therapy dog work?

What tasks or skills are you hoping the therapy dog will provide/perform or does your dog currently perform as part of ongoing therapy dog work?

What is your goal as a potential therapy dog team?

Contact Information