Service Dog Inquiry Name First Last Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneBest time to call : HH MM AM PM Email How did you hear about Canine Partners of the Rockies?CaPR trains 2 types of assistance dogs. Please check the type of assistance dog for which you are applying (check one).Mobility Service DogFacility Intervention DogCanine Partners of the Rockies specializes in training dogs for Mobility Assistance Dogs. These dogs assist people with mobility limiting disabilities. **WE DO NOT TRAIN DOGS FOR: Vision Impairment, Hearing loss, Medical alert, Seizure Response, PTSD-only diagnosis, Emotional support or Personal dogs for service.Canine Partners of the Rockies trains Facility Intervention Dogs to work in tandem with a professional who works with people with disabilities. **WE DO NOT TRAIN DOGS FOR: Vision Impairment, Hearing loss, Medical alert, Seizure Response, PTSD-only diagnosis, Emotional support or Personal dogs for service.Please explain why you are applying for this type of assistance dogIf applying for a mobility service dog, what condition/limitation does the applicant have?How long has the applicant had this condition?If applying for a facility service dog to assist you in your work, what is your profession?Have you ever been convicted of a crime? Yes No If yes, please explain:Please check the following:* I am a Colorado resident The information contained in this pre-application is correct to the best of my knowledge EmailThis field is for validation purposes and should be left unchanged.