Michigan Veteran K9 Coalition
ESA Dog Application

Name (First & Last) *

Address (Street, city, zipcode) *

Phone Number *

E-mail *

Date of Birth *

Military Status *
ActiveVeteran

Please give a brief explanation of why you think your life would benefit from an Emotional Support Animal?*

How active are you in your daily life? *

Would you be willing to take your dog to visit other veterans? *
YesNo

If you are more than 2 hours from Sturgis, Michigan you will be required to travel for handler sessions and lodging in a pet friendly hotel in the area. Are you willing to accept that expense? *
YesNo

Are you able to provide a letter from a certified counselor/therapist/psychologist, recommending you owning an ESA? *
YesNo

Have you ever owned a dog? If so please tell us about that experience. *

Have you ever owned a dog trained by someone else? *
YesNo

Have you ever surrendered a dog before? If yes, why? *

Do you currently rent or own your own home? If you rent, does the property allow pets? Are there breed & size restrictions? *

Do you have other pets in your home? If yes, please list and describe. *

How many other people live in the home with you? Adults? Children? *

Is EVERYONE in the home in favor of having a dog in the home? *
YesNo

Does anyone inside the home have pet allergies? *
YesNo

Do you have a breed, size, gender, or color preference? We utilize Labrador's, Goldens, Poodles, Pomeranians, Mini Poodles and Spaniels for the program. If you have a preference, please explain below. *

Are you financially prepared to take on the ownership of a dog? *
YesNo

Do you understand that at any point in time during or after training, Michigan Veteran K9 Coalition will have the right to confiscate your dog if it s not being properly cared for? *
YesNo

Thank you for filling out this application with Michigan Veteran K9 Coalition. This application will be reviewed by the Director of Veterans Affairs and trainer. After the application is reviewed, there will be an in person interview with the Director of Veterans Affairs and trainer, followed by a home inspection. Do you understand a home inspection must be complete before a dog is selected, trained and placed with you?*
YesNo

Majority of our dogs are sponsored by cannabis companies. The agreement between Michigan Veteran K9 Coalition and any sponsor is that the dog and selected veteran handler be photographed together at some point in the training process and published on cannabis business websites & social media. There also is the possibility of follow up media coverage with the dog and veteran handler. Are you comfortable with working with and being published on cannabis websites & social media? *
Yes, I am comfortable being published on cannabis websites & social media.No, I am not comfortable being published on cannabis websites & social media.

DEPENDING ON AVAILABILITY OF DOGS THIS PROCESS COULD TAKE 2 - 12 MONTHS TO COMPLETE.

By checking this box you accept all the above statements in this application and have answered the questions to the best of your abilities. Also by checking this box you are agreeing to a home inspection as well as accepting taking on the responsibilities of owning a dog.

Yes, I agree.