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Mercer University Students
Puppy Raiser Application Form 

Applicant Information

Current Year of Study
Are you currently involved in philanthropic support of Navicent Foundation?
Yes
No

Availability & Commitment

Are you willing and able to make a 16-month commitment to care for a future service dog?
Yes
No
Are you willing to comply with care standards and guidelines that have been established by Patient Paws Service Dogs, Inc., for the dog?
Yes
No
Are you physically able to provide playtime and exercise for the dog each day?
Yes
No
Are you able to keep your puppy on a schedule, groom them daily, work with them daily, take them everywhere you go (with a few exceptions)?
Yes
No
Are you available to attend mandatory biweekly puppy training classes?
Yes
No
Are you willing to dedicate daily time for socialization, obedience training, grooming and enrichment activities for the puppy?
Yes
No
Are you able to manage the puppy’s needs (feeding, exercise, potty breaks) while attending classes or other obligations?
Yes
No

Experience With Dogs

Have you ever had a pet dog before?
Yes
No
Have you ever experienced a traumatic dog bite that required medical attention?
Yes
No
Are you comfortable hand-feeding a dog?
Yes
No

Housing & Roommate Information

*If you are approved as a Puppy Raiser each of your roommates must complete a form confirming their approval.

Will your roommate(s) support your desire to bring a service dog in training into your shared living environment?
Yes
No
Are you and your roommate(s) willing to comply with care standards and guidelines that have been established by Patient Paws Service Dogs, Inc., for the dog?
Yes
No
Is anyone in the household fearful of dogs?
Yes
No
Is there anyone in the household with animal allergies?
Yes
No
Is there anyone in the household with concerns about shedding?
Yes
No

Family & Support System

Does your family support your decision to be a puppy raiser?
Yes
No
Not Applicable
If you travel and spend time at your family home during breaks, will your family be able to accommodate the puppy in their home?
Yes
No
Not Applicable
Are there other pets at your family home?
Yes
No
Not Applicable
If yes, do those pets get along well with other dogs?
Yes
No

Acknowledgement & Agreement

By signing this application, I confirm that the information provided is accurate. I understand the responsibilities of being a puppy raiser, including:


✔ Providing daily care, socialization, and training under the guidance of the Patient Paws Service Dog representative. 

✔ Attending mandatory biweekly training classes.

✔ Participating in a short interview process before approval.

✔ Ensuring I have the support of my roommate(s) and family.

✔ Agreeing to obtaining roommate(s) and family approval before bringing a puppy into shared housing.

✔ Agreeing to following all program training, guidelines and policies.

Date
Month
Day
Year

Patient Paws Service Dogs, Inc

1545 Mayfield Road
Alpharetta, GA  30009
 

Phone: 770-286-8018

​

Email: info@patientpaws.org

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Patient Paws Service Dogs, Inc. is a 501(3)(c) non-profit organization that provides facility dogs to hospitals and service dogs to recipients with mobility-related disabilities, at no cost to them.

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