Before completing this form, if you haven’t already done so, PLEASE REVIEW the following materials:

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

* = required

Read All Materials
Contact Information
Are you a U.S. veteran?
Environment Information
Do you have pets?
If you have pet dogs, are they spayed or neutered?
Do you have a good friend or family support system?
Are both parents willing to accept a service dog in their child’s life?
Will the dog be going to school with the child?
Service Dog Information
What type of Dog do you feel would meet your needs?

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.