Volunteer Mentor

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Volunteer to be a dog mentor

We want to thank you in advance for taking the time to fill out the Dog Mentor Application

Our Dog Mentor program is an integral part of training our Service Dogs. The Mentor takes the dog into their home, socializing, house training, working on basic manners skills, and supporting the dog during the mentoring period for the individual dog. This can be anywhere from 60 days to 12 months.

Every item in the application with a * (asterisk) requires an answer of some kind for the submission to complete.

If you have any questions, please do not hesitate to call us: 423-552-1416

Volunteer Puppy/Dog Mentor Application (Please use a computer to complete)

* Indicates required field

Date *

Email *

Name *

First

Last

Home Phone Number *

Work Phone Number *

Cell Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Are you over 18? *

Yes No

If No, date of birth: *

Employment: List Current Employer: *

Position name and description: *

Work Address *

Line 1

Line 2

City

State

Zip Code

Country

Work Phone Number *

Supervisors Name: *

Schooling - Name of last school attended: *

Studies of interest: *

School Address: *

Line 1

Line 2

City

State

Zip Code

Country

Grade Level: *

Still in school? *

Yes No

Check Days Able to Volunteer *

Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Checkmark Volunteer Interests: *

Animal Care - grooming, feeding, exercising, playing Furlough Foster Home - foster a trainee in your home - basic obedience training - additional application and interview required. Facility Maintenance - lawn mowing, trimming, weeding, light repairs, flower beds Clerical / Administrative - copying, typing, mailings, newsletter mailings, scrapbooks, display borads, record keeping Public Relations - presentations (presentations to the community - training required), information booths at area events, writing and producing newsletter Fund Raising - organizing and participating in various fund raisers Puppy/Dog Mentor - 24/7 for up to 18 months, total commitment to this individual dog Trainer - requires an additional applicaiton and an interview Grant Writer - we have the contacts and just need the grants applied for

Other Skills, Expertise or Interests: *

Other organizaitons, groups, or clubs you support or are currently involved in: please describe your levels of volunteerism by organization. *

Previous Volunteer Experience - give name of organizaiton, dates of involvement and duties while there. *

What is your Previous Experience with Assistance Dogs: *

How did you hear about CrittersWork Service Dog Partners, Inc? *

Why do you want to volunteer for CrittersWork Service Dog Partners, Inc? *

Reference 1: Please list organization you have volunteered for, support, or are currently involved in that we may contact. *

Reference 1: Phone Number *

Years/months you have known organization *

Reference 2: Please list organization you have volunteered for, support, or are currently involved inthat we may contact. *

Reference 2: Phone Number *

Years / Months you have known organization: *

Reference 3: Please list organization you have volunteered for, support, or are currently involved in that we may contact. *

Reference 3: Phone Number *

Years / Months you have known organization: *

Name, age and relationship of others living in the home with the Puppy/Dog Mentor *

Name, age and relationship of others who may stay for overnight visits: *

Where does the Primary Puppy/Dog Mentor work? *

Will you be taking the puppy/dog to work with you? *

Yes No

How often will the puppy/dog accompany you to work? *

What will the puppy do while you are working? *

Have you obtained prior written approval to tke the puppy/dog to work with you? If yes, please fax the copy to 1-800-887-6592 *

Yes No

If the puppy/dog cannot accompany you to work is there someone able to relieve and exercise the puppy/dog part way through the day? *

Yes No

If you expect to leave the puppy/dog unattended for any length of time, please explain. *

Do you travel? *

Yes No

If you travel, where will the puppy/dog be when you travel? *

Do you have friend's, neighbors, or relatives with dogs? *

Yes No

Will the puppy/dog be socializing with these dogs? *

Yes No

If you answered yes to the above question, please explain. *

What does your family do for recreation? *

Can you afford an average $50 per mongh for (hygiene, food, etc) to support a service puppy/dog in training? *

Yes No

Where will the puppy/dog sleep? *

Where will the puppy/dog rest? *

Where will you exercise the puppy/dog? *

When will you exercise the puppy/dog? *

How will you exercise the puppy/dog? *

Briefly, describe any expected challenges to your raising a service dog in training for from 2 to 16 months. *

Primary Puppy/Dog Mentor, describe your expectations regarding your puppy/dog mentor experience for CrittersWork Service Dog Partners, Inc. *

What conserns/reservations do you have with respect to becoming a puppy/dog mentor? *

Describe the environment the puppy/dog will be in when at work with you. *

Are you able to attend trainings of at least one Thursday evening of the month from 6:00pm - 8:00pm? *

Yes No

Will you devote from 1-3 hours daily to socializing, handling, loving, feeding, grooming, toiletting, and training the puppy/dog? *

Yes No

Will yu be able to take your puppy out into public for socializaiton at least 3 times a week? This means socializing the puppy/dog in malls, restaurants, schools, around other dogs, *cats, people, traffic noises, heights, bridges, balconies, and other public venues? *

Yes No

This applicaiton is an evolution, is there anything that we may not have asked that you feel is important for us to know about you or your family? *

Yes No

If the prior answer was yes, please give details. *

For the good of the puppy/dog, are you aware that this is a 2-16 month commitment? *

Yes No

Why are you mentoring a puppy/dog for CrittersWork Service Dog Partners? *

Please fax a letter of reference from you rveterinarian to: 1-800-887-6592 *

Done Not Done Pending

If you don't currently have an association with a veterinarian, please fax a letter of reference from a friend or someone you work with. To: 1-800-887-6592 *

Done Not Done Pending

Please add final comments, and type your name. When done, press Submit. By pressing submit, you agree that you have voluntarily completed this application to become a CrittersWork Service Dog Partners Puppy/Dog Mentor, and you agree to abide by CrittersWork's Puppy/Dog Mentoring guidelines and requirements. *

Submit

Bella Beagle Butt

Baxter Black

Heidi

Dunn

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CrittersWork Service Dog Partners, Inc.
357 Kitchen Branch Rd.
Greeneville, TN 37743-7266
Email us
423-299-6090 or 423-228-0410

We do not share contact information!

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GreenePets Foster Network, Inc.

Photo used under Creative Commons from Colure