Student Application

Applicant Information
Name*
First Last
Address*
Street Address Apartment/Unit City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
How long have you lived at your present address?*
Are you a citizen of the United States?*
- Yes
- No
Have you ever been convicted of a felony?*
- Yes
- No
If yes, explain:
Home Life Information
Marital Status
Spouse / Life Partner's Name
With whom do you reside?
How many adults reside with you?
How many children reside with you?
Children's age(s)?
How many pets reside with you?
Type(s) of pets who reside with you:

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Education
High School
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Attended from:
Attended until:
Did you graduate?
- Yes
- No
College
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Attended from:
Attended until:
Did you graduate?
- Yes
- No
Degree received:
Other
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Attended from:
Attended until:
Did you graduate?
- Yes
- No
Degree received:
Personal References
Please list at least three (3) personal references
Name
First Last
Relationship
Home Phone
Cell Phone
Email
Name
First Last
Relationship
Home Phone
Cell Phone
Email
Name
First Last
Relationship
Home Phone
Cell Phone
Email
Signature
I certify that the above information is true and correct:
Type name:
Signature
Use your finger or mouse to sign.
Date of signing
MM slash DD slash YYYY
Guide Dogs of America does not discriminate against race, religion, creed, gender, gender identity/association, national origin, age, disability, marital status, veteran status, sexual orientation or any other legally protected class.
Additional Forms
In addition to the application you will need to download and complete the following forms.
- Ophthalmologist Report
- Physician’s Report
- Orientation & Mobility Evaluation
- Release of Information Form
- Video (submit link below)
Ophthalmologist Report
Accepted file types: jpg, gif, png, pdf, doc, docx, txt, Max. file size: 128 MB.
Physician's Report
Accepted file types: jpg, gif, png, pdf, doc, docx, txt, Max. file size: 128 MB.
Orientation & Mobility Evaluation
Accepted file types: jpg, gif, png, pdf, doc, docx, txt, Max. file size: 128 MB.
Release of Information Form
Accepted file types: jpg, gif, png, pdf, doc, docx, txt, Max. file size: 128 MB.
Video URL
Comments
This field is for validation purposes and should be left unchanged.

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Submitting Your Application

Step 1 of 3

Applicant Information

Home Life Information

ORIENTATION AND MOBILITY TRAINING

Travel

GUIDE DOG EXPERIENCE

Health

Education

Personal References

Signature

Guide Dogs of America does not discriminate against race, religion, creed, gender, gender identity/association, national origin, age, disability, marital status, veteran status, sexual orientation or any other legally protected class.

Additional Forms

Contact Us

An International Guiding Eyes Program