Forms – Assistance Canines of Texas (ACT)

Handler Self Assessment

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Name *

First

Last

Email *

What is your CURRENT physical health? *

What is your medical history (relating to your disability)? *

What is your CURRENT age, and lifestyle factors? *

Why do you feel capable of training a service partner of the next 2.5 to 3 years? *

Why do you feel that you are a good fit for our program? *

Why do you have/need a service dog (SD)? *

Have you ever trained a service dog before? *

Do you have a dog that is entering retirement? *

Do you currently have pets in the home? *

If yes, what are their names and ages? If you already have a partner, what is the dynamic between your service partner and your pet(s)? *

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