Retrieving Independence

Skilled Companion Application

* First Name

* Last Name

Please check this box if you are a caretaker completing this application on behalf of someone

* Email

* Phone

Address

City

State

Postal Code

Gender

Preferred Pronouns

Birthday

What is your approximate height and weight?

We are excited that you are considering a skilled companion dog and have come to Retrieving Independence. Included is all the information you will need to gather and submit to begin the evaluation process.

Before you complete the application, we want to make sure you have all the information needed to make you decision to pursue a skilled companion dog through our organization.

When we receive your completed application package, the first step of the application process will be complete.

The second step is an interview, either in person or over the phone. The interview is crucial in helping us understand your needs, personality, and lifestyle which will greatly assist us in matching you with a dog. The last step is the hardest – waiting for your dog! Due to the high demand for service dogs at this time, the wait can be anywhere from 6 months to 2 years or more, depending on your needs and our current available dogs.

Thank you for your understanding. Please do not hesitate to reach out with any questions or concerns.

* What is your primary disability:

* Please list any secondary disabilities, if applicable: Is your disability progressive?

Please check all that apply: What are the effects of your disability?

Other:

Do you have problems with:

If you checked yes on seizures, what type and how often are your seizures?

What treatments or medications are you using or have you used to control your seizures?

Do you use any of the following aids or assisting devices?

Other aids or devices:

* Are you active in the military, a veteran, or a dependent of an active military or veteran? Please explain.

* Primary Care Physician, PT, OT and/or other health professionals important to your care: Name and Phone number

* Do you live in:

If Other is selected please explain:

* Is your yard:

* Please list all members of the household: Name, Age, and Relationship

* Do you have an attendant?

If yes, are they:

* Please describe your home and your neighborhood (i.e. quiet, children frequently visiting, close to retail or commercial areas, suburban, rural, heavy traffic/main street, etc.):

* Does anyone in the household smoke?

* Have you ever had a pet dog before? If so, please list all pet dogs and how long you had them.

* Do any other animals live with you or visit you frequently?

* Have you ever experienced any trauma from a dog you owned or a dog you were around that could negatively impact your relationship with a skilled companion dog?

If yes, please explain what happened.

If so, please describe (include breed, age, etc.) - who is responsible for the care of these animals?

* Who will assist in the daily care and training of your dog, if needed?

* Does anyone in your household have concerns about having a skilled companion dog in their home? If so, please describe:

* Are you (or anyone in your household) allergic to animals?

* Are you (or anyone in your household) concerned about fleas or shedding?

* Are you currently employed?

If yes, do you understand that a skilled companion dog is not a service dog and would not be able to go to work with you?

* Are you currently in school?

If yes, do you understand that a skilled companion dog is not a service dog and would not be able to go to school with you?

* Pick five of the following words that would best describe the dog you would like to have:

* Are you able to complete a hybrid of virtual and in person training sessions before final placement with your skilled companion dog?

* How do you feel a skilled companion dog could improve your life? What specific tasks are you hoping a skilled companion dog could help you with?

* Please tell us a little more about yourself and your lifestyle - hobbies, activities, clubs, interests, etc.

* List 5 words that would describe your personality.

Do you plan on moving within the next year or time within applying for Companion dog. If yes, explain why and where.

Please confirm that you understand:

I understand that I will be required to attend training in Nashville, Tennessee and I will have someone (adult, no children) accompany me through the entire camp.

I understand that a skilled companion dog is meant to assist in-home only and is not considered a service dog under the ADA law and therefore does not have public access rights.

I understand that misrepresenting a skilled companion dog as a service dog (wearing a vest, visiting non-pet friendly public space, etc.) could result in removal of the dog from my home.

I understand that RI retains ownership of the skilled companion dog for the lifetime of their working career and can remove the dog if the care and conditions do not meet our standards.

The total investment of an RI service dog is $30,000. Through generous donations we are able to offer our dogs below that cost. I understand my contribution to the total expense of an RI Skilled Companion Dog is a minimum of $8,000 (dogs placed in 2026).

I understand that if I am unable to care for my skilled companion dog or no longer need a skilled companion dog, RI will be notified and given first right of refusal to ownership of the dog.

I understand that an RI service dog is never to be sold or placed in another home without express consent from RI.

Application for a Skilled Companion

Please make sure your application is complete before submitting. Incomplete applications cannot be considered.

To complete your application please email the following to jen@riservicedogs.org

Reference Letters

1 Professional - From an employer, teacher, colleague, therapist/provider, etc.
1 Personal - From a mentor, friend, roommate, classmate, etc.

Once this documents are submitted please pay the $200 application fee to finalize your application:

Application Fees can be paid online here or by check . Checks should be to be made out to Retrieving Independence Inc. and mailed to

Attn: Retrieving Independence 2400 Clifton Avenue

Nashville, TN 37209

Please reach out to us if you have any questions and we look forward to reviewing your application!