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. We can make no exceptions. Please initial each page and sign below to indicate completion. For questions, please contact Old Glory Service Dogs at (386) 878-2244 or email@example.com.
||This is the application accompanying this checklist|
|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:||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||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.|
|5) Current Full-Length Photo:||Email your photo to firstname.lastname@example.org|
|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:|