Assistance Dogs Set in Motion Client Pre-Application

We are excited you want to be a part of Atl graphic of dog on woman's lap doing deep pressure therapy

as!

Though many disabled people can and want to participate in the training of their own service dog, starting fresh with a puppy or young adolescent is not always a viable option. This can be for a variety of reasons:

Raising a puppy may take far too great of an emotional toll.
An untrained puppy or adolescent may actually be a hazard or danger for someone with limited mobility or other type of disability.
Working with a private trainer in the early stages of training may simply be inaccessible.

Assistance Dogs Set in Motion™ is for the person who can work with a slightly more mature and skilled adolescent, but for whom finding, raising, and training a puppy and young adolescent is simply not feasible.

Through this program, a puppy will be selected for you based on your needs and lifestyle. The puppy will be raised by skilled Atlas Puppy Raisers until they are approximately one year of age.. They will work with the puppy and train them based on a specific training plan, adjusted to your individual needs. When the dog is one year old, they will be transferred to your care, and you will be set up with a detailed transfer and support plan to prepare you for Atlas’ Certification Program which you will start once your dog is 14 months old.

We have different models depending on need and available funding.

In model #1 Atlas funding has been allotted to cover some or all of the cost of the dog, including the dog themselves, travel to raiser and client, regular veterinary care, gear, food, treats etc. until the dog is approximately one year old and they start living with the client. At this point, the client will assume all costs for the care and well-being of the dog and depending on funding, may also be responsible for any remaining program costs up to certification. In this model, Atlas owns the dog up until the client has completed Atlas’ full training program and successfully passed their Public Access Test.

In model #2 the client is typically responsible for all costs and care of the puppy, including purchasing the puppy, training, medical expenses, gear, etc. from the start. Depending on available funds, Atlas may be able to offset some of the program costs in this model as well.

Before receiving Atlas' full application, please fill out this pre-application to ensure you qualify for our program. Please also ensure you have fully reviewed Atlas' Assistance Dogs Set in Motion program description.

user manual icon Our Assistance Dogs Set in Motion Program to see if our program is a good fit for you.

**Please note that Atlas Assistance Dogs is unable to provide:

Guide dogs for individuals with significant vision loss.
Service dogs for individuals who will not have the ability or willingness to participate in the ongoing training of the dog.
Service dogs for individuals who do not accept using only positive training methods.

** Please note at this time we can only serve clients in the US.

Once we receive your pre-application, we will contact you in approximately one week via email.

All information you provide is confidential and secured with very limited access to only the Atlas staff directly involved in supporting you as a client.

Please be aware, we have limited funding and limited capacity for this program. If we can't accept you into this program when we receive your pre-application, we will contact you with options and keep your pre-application on file. Thank you for your understanding and patience.

Handler Information

Is there any handler other the client

YesNo

This information should be completed pertaining to the person who will be primarily handling the dog in public venues. The handler is the person(s) able to complete all training with the dog. It is not necessary to complete this section if the client and the handler are the same person.

First Name:

MI:

Last Name:

Pronoun(s):

They/ThemShe/HerHe/HimLet me enter

Specify Pronoun(s):

Date of birth:

Preferred phone:

Other phone:

Physical Address (street):

City:

State:

Zip Code:

Country:

Email:

Handler Mailing Address:

Address:

City:

State:

Country:

Zip Code:

Client Support and Needs

Unfortunately spots in this program are extremely limited. Please help us understand your situation and why you feel this program is important for you vs starting with your own dog and working toward certification in our regular Client Certification program.

Please explain why you need to start with an adolescent dog (Approximately one year of age) vs a puppy

Please describe how you will benefit from a dog from Atlas' Assistance Dogs Set in Motion Program?

What other approaches have you taken to attempt to acquire a service dog?

Do you live with anybody else? If so, whom?

Explain the type of support you have within your home (for example: support with errands, training, emotional support etc.).

Explain the type of support you have available outside your home.

Is there anyone in the home that does not support having a dog in the home?

YesNo

If yes, who and what are their concerns?

Dog Needs

Describe your ideal dog (please note that Atlas will take into consideration your desires and preferences, but will ultimately select a dog that we feel is best suited for your needs).

Preferred breed:

Size:

Energy Level:

Coat:

Who will be primarily responsible for the dog's care?

What are some dog habits that you would not be able to tolerate?

How do you envision providing physical and mental stimulation for your dog?

In what situation might you surrender a dog?

Do you have other animals in the home?

YesNo

If so, describe?

If your present dog does not get along with your new service dog in training, would you consider re-homing your present dog?

Please describe the type of support you can rely on in times of emergency or illness. For example, will someone be available to care for your dog?

Training Background

Have you ever had a pet dog?

YesNo

Please describe the types of dog(s) and how long you had them.

Please describe any training you have done with your previous pet dog(s):

What were some challenges you faced with your pet dog(s)?

What did you enjoy about having a pet dog?

Have you ever had a service dog?

YesNo

Approximate date(s):

From:

To:

How did you you train/acquire the service dog?

How long were you a working team?

What were some challenges you faced as a service dog handler?

What were some successes you had as a service dog handler?

Can you describe your experience around dog training?

Can you describe your understanding of positive training methods?

Do you have any concerns with training a dog?

Submitting pre-application

I understand that I will not be receiving a fully trained service dog and that not all dogs are suited for service dog work.

Yes

I understand that upon transfer, the dog will have foundational skills and training but will still need refining and on-going training.

Yes

I understand that Atlas will choose a dog for me based on my needs, taking my preferences into consideration.

Yes

I understand that I must complete the Teams Set Motion Program prior to entering Atlas' Client Certification Program

Yes

I understand that I will be in communication with the Team Facilitator Puppy Raiser to follow the dog's training and prepare for the transfer process when the dog is approximately one year old

Yes

I understand that I will continue with Atlas' Certification Program when my dog is 14 months old until certification with Atlas

Yes

All information provided in this application is complete and accurate to the best of my knowledge.

Yes

Client Name:

Date:

Primary Handler or Guardian's Name(If client is under 18 or if dog is primarily handled by another adult). Guardian should be the one signing and is agrees all answers in this application are accurate: