Hearing Dog Application

Dear applicant,

Thank you for choosing to apply for a Hearing Dog from The Sam Simon Foundation.

Our application process involves several guided steps which helps us determine if we are the right program for you. If approved to our waitlist, waiting times can vary before being matched with a dog. In general, we keep wait times up to 1 year or less for those applying for large dogs. Applicants wishing to be matched with small to medium sized dogs or those considered “hypoallergenic” may have a considerably longer wait time due to availability constraints.

Please print and fill out our Hearing Dog application which ends with a signature page. In addition, you will see a Release of Liability waiver to sign and an Audiogram Release Form with Questionnaire to sign and then given to your audiologist to complete.

The Sam Simon Foundation does not require an application fee to be considered for a Hearing Dog. Once we have had an opportunity to evaluate your application, we will notify you by mail or email with next steps.

If you have any questions about your application or the additional forms, please notify us by email, fax or phone.

Please mail all forms to: The Sam Simon Foundation Assistance Dogs Program, 30765 Pacific Coast Highway, #113, Malibu, CA 90265.

Completed and signed Hearing Dog Application
Signed Release of Liability
Completed Audiogram Questionnaire and including a copy of your last audiogram

We look forward to working together and appreciate your trust in us to help you navigate this process.

The Sam Simon Foundation
Assistance Dogs Program