Paws for Life USA - Client Application Video Outline - Part C

Please provide a 10-15 minute video and submit with Part A of your application.

Your video is critical. Paws for Life USA reviews it frequently during the placement process:

-Initially, to see IF we can have the right dog for your needs and accept you as a client -When matching teams, to evaluate whether a dog in training fits your lifestyle and your needs -During custom-training of the dog to meet your needs
Name

Describe yourself:

Name and address. Tell us about your family, friends, and personal attendants. Tell us about your pets (past and present). Describe your daily routine – work, school, and other activities.

Describe your disability – Tell us about:

 The history of your disability.  Your accomplishments.  Your limitations.  Your activity level.  Your daily routine

Demonstrate your mobility level:

 Show us how you move around inside your home and workplace or school.  Show us how you use your adaptive equipment.  Show us how you transfer.  Show us your mode of transportation outside your home.

Describe what your dog would do:

 How do you think a dog will be able to help you?  What skills would you need?  What are your expectations of an assistance dog?  Do you currently have or have you ever had a service dog? If so: a. Where did you get your service dog (organization, private trainer, self-trained, other)? b. How many years did the dog work with you? c. If you still have the dog, show your service dog interacting with you.

Show your environment:

 Home – Video the interior and exterior of your home, your yard (including any fencing), and your neighborhood (where you might walk with your dog)  Show your interaction with any present pets you may have.  Other – Video your work, school, recreational and/or social environment.

Instructions

Please list the name and contact information of two people who will provide letters of recommendation for you.

1) Personal (not a relative), 2) professional (therapist, doctor). Please send letters of recommendation to: Paws For Life USA P.O. Box 72016 Marietta GA 30007-2016 Fax 770-579-8289 admin@pawsforlifeusa.org

Signed:

Name
MM slash DD slash YYYY
Time
:

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