How are the students chosen?

A sightless person who is physically and mentally capable of receiving benefit from the Pilot Dog may apply. Students of all races and creeds are served after being approved by the school’s Student Selection Committee.

Download the Application or Complete the form below.


Instructions for Applicants

  1. Please complete the application form by typing or in legible pen and ink. Answer all questions as fully as possible.
  2. Please provide a list of four references and include their e-mail address and full mailing address. These references should be persons, other than family members, who know you well and whose judgment concerning your living conditions, character, and personal habits can be trusted.
  3. A full-length snapshot taken recently should accompany the return of the application. These can be ordinary camera shots but must be full length, and at as close a view as possible to show height and weight proportions.
  4. When we receive your application we will send you additional paperwork, including an eye report to be filled out by your eye doctor and a medical form to be filled out by your physician.
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Application for a Pilot Dog
Today's Date
Title
First Name
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NameMiddle
Last Name
Date of Birth
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Street AddressLine 1
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Street AddressLine 2
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City
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State
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Zip
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Cell Phone
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Home
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Height
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Weight
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Medical Insurance Company
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Name of Persons in your homeAge & Relationship to you
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List the Number & Types of Pets in your home
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Emergency ContactName & Phone Number
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Agency of O&M Training
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On average how many blocks do you travel independently a day?
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Do you use any of the following:
CommentsPlease list your duties and/or your future plans
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Dog Guide School AttendedDate Attended
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Cause of Blindness
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Date of Blindness
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References: *Provide Full Address and Email (if they have one)*
List (4) Friends, clergy, co-workers, neighbors, (not relatives), O&M Instructors or Counselors

Reference #1Full Address & Email
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Reference #2Full Address & Email
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Reference #3Full Address & Email
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Reference #4Full Address & Email
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IN ALL CASES, THE TRAINER MAKES THE FINAL SELECTION OF DOG TO MATCH THE WORKING ABILITIES AND NEEDS OF THE STUDENT

Breed PreferenceCheck all the apply
Do you agree not to use Pilot Dog for Mendicancy?We consider mendicancy the acceptance of money without rendering comparable service or merchandise
Full-Length Photo of yourselfupload
cloud_uploadUpload
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