Guide Dog Foundation For The Blind, Inc.® Student Application

All information is privileged and will be considered confidential.

* Fields marked with an asterisk are required.

Section 1 of 4: Demographics

1. Please provide your contact information.

* Name


Date of Birth


* Address line 1

Address line 2


* City


* State


* Zip


Country

All Non-U.S. Citizens must possess a current passport to travel to and from the U.S. per International Law.

* Home phone


Work phone


Cell phone


E-mail address



2. Will you be at least 16 years of age when you are available for training?
* Yes, I will be at least 16 years of age when I am available for training
No, I will be less than 16 years of age when I am available for training

3. If you are not fluent in English, in what language(s) are you fluent?


4. In what format would you like to receive correspondence/information from the Guide Dog Foundation? Please indicate your top three choices.

* First Choice for correspondence: Print Large print Braille Email CD-ROM

* Second Choice for correspondence: Print Large print Braille Email CD-ROM

Third Choice for correspondence: Print Large print Braille Email CD-ROM

5. *How did you hear about the Guide Dog Foundation?


6. Are you a Veteran of the U.S. Military?
Yes, I am a Veteran of the U.S. Military No, I am not a Veteran of the U.S. Military

If yes, are you active duty?
Yes, I am on active duty No, I am not on active duty


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