Application for Accelerated Orientation and Mobility Training |
Application Introduction
Thank you for your interest in becoming a client of Leader Dogs for the Blind. Please note that this is not an application for employment or to become a volunteer.
Before you begin the application, please be aware that you will need a considerable amount of time available to complete it. Some of the information you can gather ahead of time will be:
1.Your emergency contact name and phone number.
2. If applicable, the name of the Lions Club involved in your enrollment.
3. Information regarding Orientation and Mobility training you have received to include the date, organization name, instructor, address, email and phone number.
4. The Leader Dog Application requires six personal references. Please be sure to include each reference's name, complete address, email and phone number. We prefer that your references are not immediate family members.
Please be sure to complete all required fields. All required fields are preceded by an asterisk. Should you reach an error page, please use the back button on your browser to return to your application. Once you successfully submit your application, you will be directed to a confirmation page. Here you can download the Consent to Release Information form. This form must be printed, signed and returned to Leader Dog so we may begin processing your application. You may also download a Medical History and Physical Examination form and an Eye Care Professional form. These forms must be completed by the appropriate doctor and returned to Leader Dog prior to consideration of your application by the Admissions Committee.
Before you begin the application, please be aware that you will need a considerable amount of time available to complete it. Some of the information you can gather ahead of time will be:
1.Your emergency contact name and phone number.
2. If applicable, the name of the Lions Club involved in your enrollment.
3. Information regarding Orientation and Mobility training you have received to include the date, organization name, instructor, address, email and phone number.
4. The Leader Dog Application requires six personal references. Please be sure to include each reference's name, complete address, email and phone number. We prefer that your references are not immediate family members.
Please be sure to complete all required fields. All required fields are preceded by an asterisk. Should you reach an error page, please use the back button on your browser to return to your application. Once you successfully submit your application, you will be directed to a confirmation page. Here you can download the Consent to Release Information form. This form must be printed, signed and returned to Leader Dog so we may begin processing your application. You may also download a Medical History and Physical Examination form and an Eye Care Professional form. These forms must be completed by the appropriate doctor and returned to Leader Dog prior to consideration of your application by the Admissions Committee.