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Request an Application

Please complete the following form to request an application. If you need help filling out the form, please call our Administrative Office at 1-800-393-3641 Pacific Time. You may also call us and ask for an Application Form to be mailed to your home.

  • Prospective students must be at least eighteen years old.
  • All applicants must have orientation and mobility training, with at least six months of independent travel experience.
  • While we work with many and differing degrees of visual impairment, we find our dogs are best suited for those who have a definite need for a working dog.
First Name  
Last Name  
Email Address  
Phone Number
Mailing Address
City
State
Zip Code
Have you had mobility training?
Yes, I have had mobility training.
No, I have not had mobility training.