Dear Veteran,
Thank you for your interest in applying for one of our Service Dogs.
Once you have completed this application, please double check to see that you have answered every question completely. The more information you can provide us the better we can assist you.
Once we have received your application, we will be sending you a packet by mail that contains
(2) Personal Reference Forms and (1) or more Applicant Medical Information Forms and (1) Applicant Health Evaluation Form that must serve as your referral from a licensed psychologist, psychiatrist or mental health counselor under which you are currently receiving regular treatment (counseling). All of these forms are to be mailed back to us using the self addressed stamped envelopes.
After we have received all of the forms, we will contact you to set up an in-home interview. The interview will take about an hour and we would prefer to include anyone living in the home that would have regular interaction with your Service Dog, unless there is a reason why someone should not be included. This will also give us a chance to learn more about you and how a Service Dog could be most helpful for you. Additionally, you will have the opportunity to learn more about us and ask questions. All information that is shared with us is kept confidential.
Completing this application does not guarantee that we will be able to match you with a Service Dog. We will maintain communication with you through the whole application process. However, should we feel at any point in the process that we cannot help you with one of our dogs, we will explain our decision in writing by registered US mail.
A Service Dog can be a wonderful choice for many veterans and we thank you for allowing us to be able to serve you as you have served us.
The Sam Simon Foundation Assistance Dogs Program
Service Dogs for Veterans
30765 Pacific Coast Hwy #113 Malibu, CA 90265
Office:(310) 457-5898
Fax:(310) 457-9312
info@samsimonfoundation.org
www.samsimonfoundation.com
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PLEASE MAIL YOUR APPLICATION TO:
The Sam Simon Foundation Assistance Dogs Program,
30765 Pacific Coast Hwy #113,
Malibu, CA 90265
The Application Process:
Our application is available to be downloaded at the bottom of this page. If you are not able to print it out, please phone our office and we will be happy to mail one. Any information that you share with us will be kept confidential and not shared with anyone that you have not given us permission to do so.
Once we receive your application, you will be sent (2) personal reference forms (1or more) Medical Information Forms (if you are regularly treated for a physical condition) and (1) Health Evaluation form which is to be given to your mental health provider and will serve as your referral. Once we receive your referral and other forms by mail, we will contact you if we will be able to consider your application for an in-home interview.
The purpose of an in-home interview is to determine if one of our dogs is able to be helpful for you. If you are accepted for one of our Service Dogs, we will place you on our wait list which can be up to a one year wait. If we are not able to accept your application to our wait list, we will refer you to other agencies.
If you are matched with a Service Dog, an in-home placement will be scheduled with you and you can expect to work with a trainer in public setting and in your home for several or more hours over a period of 3-5 days. If you live locally to Malibu, some of that orientation may be done at the Foundation prior to a trainer working with you in your home and in public. Following placement, there will be regular follow up scheduled that may be done in writing, over the phone and in person. Follow up is ongoing during the life of your dog and vital to your success as a team.