Keystone Human Services

Susquehanna Service Dogs

Application Process

If you haven't already done so, PLEASE REVIEW the Application Process before completing this form.

Preliminary Application Form

To begin the application procedure to receive a Service Dog, Balance, or Hearing Dog, please provide the following information:

* denotes required information

Contact Information

Date of Birth
Occupation
Service Dog Information


  • Service Dog
  • Balance Dog
  • Hearing Dog
  • Other (explain)


Comments

When you have completed the entire form, please click on the SUBMIT APPLICATION button below. Your request will be forwarded to the Partner Selection Committee, and processed as soon as possible.

PLEASE NOTE that Susquehanna Service Dogs places dogs only within the state of Pennsylvania, and selected out-of-state locations.

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Summer Camp 2010
Assistance Dogs International

Susquehanna Service Dogs is a fully accredited member of Assistance Dogs International.

This page last updated on:
May 10, 2010