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 (Required)	An email address is required to submit this form.Invalid format.
Phone
Address
City		State	Zip
Have you had mobility training?	Yes, I have had mobility training. No, I have not had mobility training.