Paws of War Service Dog Application

At this time, Paws of War is only able to provide service dogs near Long Island, NY and New Bern, NC. This program requires the adopter to train with their service dog until the dog becomes certified. WE ARE NOT ABLE TO PROVIDE ALREADY TRAINED SERVICE DOGS AT THIS TIME.

THIS APPLICATION IS FOR VETERANS, MILITARY MEMBERS, FIRST RESPONDERS, AND GOLD STAR FAMILIES ONLY. A Gold Star Family is one that has lost an immediate family member as a result of military service.

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Mobile Phone Number *

Home Phone Number *

Email Address *

Marital Status *

Single

Married

Widowed

Divorced

Sex *

Male

Female

Age *

Children *

If yes, please list their names and ages:

What is your Facebook account name? *

What is your Instagram account handle? *

What is your Tik Tok account handle? *

Place of employment *

Annual Household Income *

Will you be moving or relocating in the near future? If so, when and where? *

Are you a United States military veteran, active military, a first responder, or Gold Star Family member? *

Veteran with Honorable Discharge

Veteran with Dishonorable Discharge

Veteran General Discharge under Honorable Conditions

Active Duty Military

First Responder

Gold Star Family Member

Branch of Service *

Years Served (If still serving, enter start date) *

Campaign *

Have you ever been convicted of a NJP, Court-Martial, Or Felony? *

Yes NJP

Yes Court-Martial

Yes Felony

None Of The Above

Please provide your social media links: Facebook, Instagram, LinkedIn, and/or Twitter *

Please Upload Your DD214

If you dont have access to your file electronically, please mail a copy to Paws of War, 127-6 Smithtown Blvd.
Nesconset, New York 11767

Medical History

Do you have: *

Please list all other current disabilities, physical limitations, medical conditions or injuries and provide a description of each: *

Do you use any equipment that your service dog would have to become accustomed to? (Such as a wheelchair, cane, etc.) *

If yes, what type of equipment?

Do you have a legal caregiver? *

If yes, how many hours a day?

Doctor's Name *

Doctor's Last Name *

Doctor's Street Address *

Address Line 2

City *

State *

Zip Code *

Doctor's Phone Number *

Emergency Contact First Name *

Emergency Contact Last Name *

Emergency Contact Street Address *

Address Line 2

City *

State *

Zip Code *

Emergency Contact Phone Number *