About CDK
Give
Get Involved
Our Scholarship Kids
Events
Resource Center
Donate
About CDK
Give
Get Involved
Our Scholarship Kids
Events
Resource Center
Donate
Scholarship Application
To be considered for a scholarship, please complete be below form.
Scholarship Application
General
Training organization supplying service dog
*
Name of contact at training organization
*
Applicant Information
About You
Request Filled Out By
*
Relationship
*
Contact Email
*
About The Applicant
Applicant Name
*
Applicant Email
Gender
*
Male
Female
Applicant Street Address
*
City
*
State
*
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip Code
*
Applicant Work Phone
*
Applicant Home Phone
*
Date of Birth
*
Disability Information
Briefly tell us about your disability in your own words
*
Is your disability progressive?
*
Yes
No
If yes, please explain
You needs and expectations
Why Do You Want A Service Dog?
*
Please describe how your disability affects your life, the lives of the people close to you
*
What is your current level of independence? What special tasks/skills will your service dog perform for you?
*
How will your independence change with the aid of your service dog
*
References
How did you hear about CDK?
*
First Personal Reference (cannot be related to you)
First Personal Reference - Name
*
First Personal Reference - Address
*
First Personal Reference - Email
*
First Personal Reference - Phone
*
Second Personal Reference (cannot be related to you)
Second Personal Reference - Name
*
Second Personal Reference - Address
*
Second Personal Reference - Email
*
Second Personal Reference - Phone
*
Medical/Professional Reference (cannot be related to you)
Medical/Professional Reference - Name
*
Medical/Professional Reference - Phone
*
Medical/Professional Reference - Contact Information
*
Additional Comments
Additional Comments
reCAPTCHA
If you are human, leave this field blank.
Submit Application
Δ
Learn About Us
Change A Life
Contribute
Shared Stories
Resources
eNewsletter Subscription
Donate Today
Our Scholarship Kids
Newsletter
Resource Center
CDK For You
ADA Links
Articles
Community
Educational Resources
Family
Videos
News
fundraisers
In Memory
Press Releases & Announcements
TV Shows / Radio Interviews
Scholarships
It's easy to apply!
→ Apply now! ←
Recent News
Harvest Hound Festival!
15 Sep 2022
What to Wear
2 Aug 2022
What to Expect
2 Aug 2022
CDK In The Media
Community & Corporate Leaders