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.

Hope For Our Heroes Gala
Reserve Your Ticket

Hope For Our Heroes Gala