Please enable JavaScript in your browser to complete this form.Name *FirstLastAddress *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone *Email *Family members in home Selected Value: 0 Age of applicant *Applicant occupation *Name and age of each family member in the home *Occupation of each household member *Please let us know how your family has been directly impacted by gun violence. *When did this occur? *What do you think a support animal would provide for you or your family? *Do you have someone who can take care of the dog on a consistent basis? *What kind of home do you live in? (house, apartment, condo, etc.) *Do you have the financial ability to care for the dog on an ongoing basis? *Will you be willing to share updates on your pup should you be eligible? *YesNoHow did you hear about us? *What role do you think a dog will play in your life? *For how many hours do you think the dog will be alone during the day? Selected Value: 0 The PDSA says dogs shouldn't be left alone on a regular basis for more than four hours. Modern Dog Magazine says crated dogs shouldn't be left home alone for more than three or four hours. PAWS Chicago, a nonprofit no-kill shelter, says five to six hours is the max for an adult dog.Do you or your family currently have a dog? *YesNoIf you do please provide details on name, age, & breed. *Have you or your family previously had a dog? *YesNoIf you have, please provide more details of when you had the dog and for how long. *Do you have any other pets? *YesNoList them below including type of pet and age of pet. *Do you have a yard for the puppy to exercise and run around in? If yes, is it fenced in? *Do you have an idea of costs for grooming in your area (as goldendoodles require regular grooming)? *Do you have a vet you already know of and would use? *If you go away do you have a dog sitter in your area you would use? *If you work, do you have any dog walking services in your area? *Does everyone in your family want a new puppy? *Is there anything else you would like for us to know? If so, please provide a personal statement.Would you be willing to provide us with photo updates of your pup? *ReferencesPlease list the name and phone number of three references as well as their relationship to you. 2/3 references cannot be friends or family.Reference #1 Name *FirstLastReference #1 Phone *Reference #1 Relationship *Reference #2 Name *FirstLastReference #2 Phone *Reference #2 Relationship *Reference #3 Name *FirstLastReference #3 Phone *Reference #3 Relationship *Submit In Partnership With