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Veteran application

Thank you for taking the time to complete our application. Submitting an application does not guarantee acceptance into the program, but it does begin our interview process. Please allow up to 3 business days after submission for a member of our team to contact you to schedule an interview.

Veteran Information

First name*

Last name*

Birthday*

Month

Day

Year

Phone*

Email*

Address*

City*

Zip Code*

State*

Preferred Contact Method*

Military Service

Branch of Service*

Years of Service*

Discharge Status*

Do you currently receive VA care?*

Yes

No

Support Needs

What challenges are you hoping a service dog may help with?*

PTSD

Anxiety

TBI

Mobility Support

Medical Alert / Medicine Reminders

Sleep & Nightmares

Other

Are you currently working with a therapist/VA provider/Medical Professional?*

Yes

No

Lifestyle & Readiness

Do you have stable housing?*

Yes

No

Do you have other pets?*

Yes

No

If yes, tell us about your pets (type, age, temperament).*

Do you personally own or have consistent access to a vehicle that you are legally able to drive and that can safely transport a service dog?*

Yes, I own a vehicle and have a valid driver's license.

Yes, I have consistent access to a household/shared vehicle and can drive it.

No, but I have another reliable transportation arrangement.

No, I do not currently have access to a vehicle.

Are you able to attend training sessions and follow program requirements?*

Yes

No

If your Walking With Honor dog required immediate or emergency veterinary care, would you be able to transport the dog to a veterinary hospital at any time, including nights, weekends, and holidays?*

Yes

No

Unsure

Long answer

Expectations & Commitment

Why are you interested in a service dog through Walking With Honor?*

What does "commitment" mean to you in caring of a service dog?*

Consent & Acknowledgment

I understand submission does not guarantee acceptance into the program.

I agree to participate in interviews and assessments if selected.

I acknowledge that Walking With Honor is a federally recognized 501(c)(3) nonprofit organization. I understand that participation in the program is subject to the organization's policies, procedures, and eligibility requirements.

I certify that the information provide is true and accurate.

I understand that Walking With Honor may conduct a background check as part of the application and placement process. I authorize Walking With Honor to obtain information regarding my criminal history and other records deemed necessary to evaluate my eligibility for participation in the program.

I understand that any information obtained will be used solely for program-related purposes and will be handled in a confidential manner. I have read and understand the above statement and authorize Walking With Honor to conduct a background check.

How did you hear about us?*

Walking With Honor

603-408-7463

info@walkingwithhonor.org

PO Box 19

Bradford, NH 03221

Walking With Honor is a registered 501(c)(3) nonprofit organization.. EIN: 41-3214623.

Donations are tax-deductible to the fullest extent allowed by law.

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