Facility Dog Inquiry

Filling out an inquiry for a service dog program is the first step in our application process. At this stage, we ask for basic information about your needs and eligibility, which allows us to better understand how a service dog could potentially support you. Please note that completing the inquiry form does not guarantee approval or enrollment in the program. It simply helps us assess your situation and determine if a service dog is the right solution for your needs. After reviewing your inquiry, we may reach out for further clarification or to discuss next steps, which may include submitting additional documentation or undergoing a more detailed assessment before any decisions can be made.

Todays Date *

Name of Applicant for the Dog *

First

Last

Name of Person completing this Inquiry *

First

Last

Date of Birth of the applicant for the dog *

I am applying for the following type of dog: *

Facility Dog: a specially trained dog that works with a volunteer or professional in a residential or clinic setting. The dog must be trained to do specific, skilled tasks in a variety of different situations within the facility environment with multiple clients; it must be more than just a presence within the facility. ADI certified Facility Dogs and their handlers are trained to the same standards as ADI certified Assistance Dogs. In some countries facility dogs do not have any public access while in other countries public access is permitted only when the dog and trained handler are directly working with a client with a disability.
Courthouse Facility Dog: Trained by an ADI accredited member organization to do specific, skilled tasks in a variety of different situations with a variety of people in need of their services in such places as a courthouse or child advocacy center. Their handlers, professionals who are knowledgeable about the practices of the justice system, utilize the facility dog to provide a calming influence on vulnerable people during the investigation and prosecution of crimes, other stressful legal proceedings, and therapeutic responses to these experiences. Given the nature of this work, prior to graduation from team training, the team must be able to demonstrate that they can work in community places, such as a courtroom, courthouse or police station without creating a public nuisance that could have an adverse impact on the proceedings. Public access for the facility dog is only granted with permission from the institution or under provisions of state or federal/national laws.

My facility includes (check all that apply): *

Schools and Educational Settings
Therapy Centers and Rehabilitation Clinics- outpatient
Nursing Homes and Assisted Living Facilities
Hospitals and Healthcare Facilities
Jail/ Prison
Courthouses and Legal Settings
Mental Health Facilities and Counseling Centers
Other

Email *

Phone *

Your Home Address *

Address Line 1

Address Line 2

City

State

Zip Code

Where do you live *

Single Family Home
Townhome
Apartment
Other

Do you rent or own? *

How did you hear about PGI? *

ALL APPLICANTS: Describe your Home and Liftestyle

What is your current daily Level of activity Semi Active Active

Active (I leave my home daily)
Semi Active (I leave my home at least 3 times a week)
Home Bound (I leave my home 1 time a week or less)
I spend the majority of my day in bed

Who lives in the home (please list all adults and children) *

What animals live in the home? (please list all animals and types) *

Are all the animals in the home up to date on vaccinations? *

Are all the animals in the home spayed/neutered? *

Are there any areas in your home, job or the facility that would pose a safety concern for a dog (e.g., stairs, sharp objects)? *

Do you live in a place where a dog is allowed (e.g., landlord approval, pet policies)? How would you handle your dog when you're at work, in public spaces, or traveling?

Have you ever been convicted of a crime? AND/OR animal neglect or abuse? *

If yes please describe

Please include photos of the applicant’s home (inside, outside) and yard. *

Click or drag files to this area to upload. You can upload up to 4 files.

FACILITY DOG INQUIRY ONLY

If inquiring about a FACILITY DOG, name of facility and address of facility

If inquiring about a FACILITY DOG, who will own the dog. This person will be responsible for taking the dog to work each day and home at the end of day. Please list name and contact information. How long have they been in their current position?

If inquiring about a FACILITY DOG do you have supervisor/ administration approval?

What is your goal of adding a working dog to your life? *

Can you explain what skills or behaviors you believe a dog could assist with for you? *

What do you understand about the role and responsibilities of having a working dog? *

All Applications- Questions related to our program

Do you currently reside in illinois? *

Are you able to attend weekly training classes in Peoria IL *

Can you afford $600-800 a year for vet care and grooming for a dog? *

Yes
No
Im not sure

Are you willing to commit to annual re-certification tests for a working dog and continued training for the life of the dog? *

Acknowledgement of Process *

I understand this is only a basic inquiry form and does not complete my application or approve me for a service dog. Future steps are needed before my application is complete.

Check to acknowledge agreements before submitting inquiry *

By signing this I understand Paws Giving Independence reserves the right to deny any applicant for any reason. I understand Paws Giving Independence does not have to give me a reason for a denial of an animal. In my participation with Paws Giving Independence and Helping Paws I do hereby agree to hold free from any and all liability the Paws Giving Independence/Helping Paws and its members, board members, staff, volunteers and officers. My family, members of my household and myself waive the rights and claims for damages and injuries, which may come from connection and participation with PGI. I declare myself to be physically sound to participate with the PGI. I understand PGI can remove a dog from my home at any time due to failure to fulfill these terms, conditions, policies, and procedures of Paws Giving Independence. I understand any dog that is placed with me through Paws Giving Independence will legally belong to Paws Giving Independence until placement paperwork is signed. By providing contact information I am giving PGI permission to contact my vet and references. I understand, service dogs are highly trained in many commands, but they are not machines that will respond automatically to commands. I understand a PGI dog cannot take responsibility for the safety of the recipient.

Review of Info *

I understand PGI will review my information and decided if I am a fit for moving forward with their program. If they would like more information they will email me a complete application to fill out. This Inquiry does not guarantee me acceptance for a service dog. Our recipients are chosen from those who can best benefit from the skills of our dogs.

The information contained in this online inquiry is correct to the best of my knowledge.

PGI prohibits discrimination based on race, sex (including pregnancy, childbirth or related medical conditions), religious creed, color, national origin or ancestry, physical or mental disability, medical condition, marital status, age, sexual orientation, citizenship status, military service or veteran status, gender identity and gender expression or any other basis protected by federal, state or local law or ordinance or regulation.

Signature *

Clear Signature

** We do not self-train your current animals for our program.