To be considered for a scholarship, please complete be below form.
Request Filled Out By: *
Applicant Name: *
Applicant Home Phone
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Applicant Birthdate: JanFebMarAprMayJunJulAugSepOctNovDec 12345678910111213141516171819202122232425262728293031,
Briefly tell us about your disability in your own words:
Is your disability progressive? * YesNo
If yes, please explain:
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
How did you hear about CDK?
Please note: If you hit submit and the page does not change, please check over your answers to ensure you’ve filled out the form completely.
8 Jan 2020
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