Application

Old Glory Service Dogs 4 Veterans Application Checklist

To apply for an Old Glory Service Dogs 4 Veterans Service Dog, please complete these items and ensure that they are all received by Old Glory in Bunnell, Florida within no more than 60 days of each other. Certain documentation is required prior to your approval. The quicker we receive this information the faster the process will go. We understand we are asking for a lot, but this information is crucial to the organization’s funding. We can make no exceptions. You will be able to enter the information in the upload box in each part of the checklist.  For questions, please contact Old Glory Service Dogs at (386) 878-2244 or info@oldgloryservicedogs.org. 

 

Medical Forms are Mandatory with Application. Please Print out the forms and have them filled out by you Physician. You can submit them in the download box on the application. 

Member Application:	This is the application accompanying this checklist	Completed
2) Mental Health Verification Form:	The form must: Be filled out by your current mental health care provided who is a psychiatrist, psychologist, or other licensed mental health care professional (LCSW or higher)
	Verify your service-related PTSD, TBI, and/or MST diagnosis and other relevant mobility disabilities
	Be signed and dated no more than 60 days before you complete the application
3) Primary Care Physician’s Report:	*****Required with Application***** Members are expected to train one (1) day per week for an hour and half. Training will be done at Old Glory’s building or in public. Training will include walking/moving, standing, sitting, bending at the waist, and kneeling down. Training can be outdoors, in crowds, or inside.
4) DD-214 (Member Copy) or Letter/ID of employment	*****Required with Application****** You must include every DD-214 you have received. Or letter from employing agency/ agency ID
	If you are/were National Guard or Reserve, an NGB Form 22 may suffice. Please contact Old Glory.
6) Command Authorization:	If you are Active Duty please contact the Old Glory Team
7) Two (2) Agreement to Support Forms:
8) Any Other Documents That our Old Glory Team Requests:
Live within 70 Miles of 101 Hibiscus Ave, Bunnell FLorida

If you are a Military Veteran, Law Enforcement,  Firefighters & EMS who has been diagnosed with TBI, MST, PTSD, and/or other service-related mobility disability and would like to find out if a service dog would benefit you, please feel free to contact us at : info@oldgloryservicedogs.org. In this family, No one fights alone!

 

 

 

 

(Note: Please download the PDF forms if you wish to fill them out in Adobe, as not all web browsers are compatible with fillable PDF forms)