R.W.B. DOG T.A.G.S.

Apply to the Program

Start with the application pathway so the team has the details they need.

Use the secure application form below to start the participant application process. A complete application should include a referral from the VA or Wounded Warrior Project.

The form mirrors the current R.W.B. DOG T.A.G.S. participant application and gives the organization a cleaner way to review and manage submissions through the website admin.

Start Application Contact First

Applicant Information

Last Name *First Name *M.I.

DateEmail Address *

Street Address

Apt/Unit #CityStateZIP

Phone *Emergency Contact Phone

Emergency Contact

Military Service

BranchFromTo

MOSType of Discharge

If other than honorable, explainDeployment History

Employment History

Employer 1

CompanyFromTo

AddressPhone

Job TitleSupervisor

Responsibilities

Employer 2

CompanyFromTo

AddressPhone

Job TitleSupervisor

Responsibilities

Medical Conditions and Service Animal Tasks

List medical conditions and tasks you may need a service animal to perform.

1.2.3.4.5.

General Information

Are there children in the home?Age(s)

Other people living in the home?Other pets in the home?

Household members: name, age, relationshipPets: number, type, age

Type of homeIf other, specify

Does anyone in the home smoke?Does anyone in the home use drugs?

Have you ever been convicted of a felony?Investigated for animal cruelty or neglect?

If felony, explainIf animal cruelty/neglect investigation, explain

References

Please list three personal or professional references.

Reference 1 Full NameReference 1 Phone

Reference 2 Full NameReference 2 Phone

Reference 3 Full NameReference 3 Phone

Referral, Disclaimer, and Signature

Referral Source / NotesReferral Document Upload PDF, Word, JPG, or PNG. Max 8MB. I understand that a VA or Wounded Warrior Project referral is required for a complete application. I certify that my answers are true and complete to the best of my knowledge.

Signature *Date