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 wait list, waiting times can vary before being matched with a dog. In general, we work to keep wait times up to 1 year or less but may be longer depending on the dogs we have in training, as well as individual needs.

Please note as of 2021: Due to limited availability, we will temporarily be unable to approve applications for dogs under 35 lbs. in weight. When this status changes, we will remove the notation and resume applications for all sizes of dogs.

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 to let you know 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

Hearing Dog Application

To apply for a Hearing Dog, you will need to fill out an application and send it back to us along with an audiogram from an audiologist.

After your application has been reviewed, you will be notified as to whether or not you qualify for the next step. That next step will be an in-home interview by one of our Instructors.


Continue to Application Form