Enrollment

    Active DutyRetiredVeteran
    Does anyone in the family suffer from allergies?
    YesNo
    Do you currently have dogs?
    YesNo
    Are you currently employed?
    YesNo
    Diagnosis (Check all that apply):
    PTSDTBIAdditional Mobility Issues (i.e. back pain)
    Help Us Secure Funding: The purpose of these questions is to gather data that could be helpful when providing anonymous statistical information for program funding opportunities. Your answer is voluntary, and in no way affects your eligibility for enrollment.
    Gender
    FemaleMale
    Branch
    ArmyNavyAir ForceMarinesCoast GuardNational Guard
    Ethnicity:
    CaucasianAfrican AmericanAsianHispanicNative AmericanOther
    Insurance Provider (check all that apply):
    VAMedicareMedicaidBCBSOther
    Annual Household Income:
    $0-$18,000$18,000-$25,000$25,000-$32,000$32,000-$40,000$40,000-$50,000$50,000+
    I understand that the Hope Lives Here program, if enrolled, takes 9 to 12 months to complete. The program requires attendance to multiple weekly sessions, including, but not limited to, training, workshops, and so on. Hope Lives Here gives the option to have my own dog assessed for the program if it meets the age, size, and health requirements. If I adopt a dog through the program, I understand Hope Lives Here obtains dogs from local shelters. Dogs adopted from shelters are taken home the day of adoption with no previous service dog training.

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