Pets with a Purpose Dog Application1 Pre-Qualification2 Personal Info3 Family & Environment4 Dog Info5 Personality Match6 Other Info & AcknowledgementPre-Qualifying QuestionsPlease answer the following questions before to determine if you meet the basic requirements for adopting a Career Change dog. We have a long application and these questions are intended to help determine if you are eligible to continue in the application process.Are all family members in agreement about receiving a PAALS dog?*YesNoIs anyone in your household allergic to animals?*YesNoAre you willing and able to exercise the dog on a regular basis?*YesNoAre you willing and able keep the dog on a leash when outside and not in an enclosed area?*YesNoWill you be able to keep your PAALS dog as an inside "house" dog?*YesNoWill the PAALS dog be left alone for four or more hours on a regular basis?*YesNoAre you willing and able to come to Columbia, SC to pick up the dog?*YesNoWe are sorry, but you do not qualify to become adopt a PAALS Career Change dog at this time. Should your situation change in the future, please consider re-applying at that time.Congratulations. You have pre-qualified for a PAALS Career Change dog placement. Click on the "Continue with Application" button to complete and submit your application now. Alternately, you may click on the "Save and continue later" link to complete the application later. (A link will be displayed specific to your application which you can email to yourself.) Save and Continue LaterPersonal InformationApplicant Name* First Last Address* Street Address Address Line 2 City StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email Address* Enter Email Confirm Email Home Phone #*Mobile Phone #*Work Phone #Most convenient time and number to call:*What branch of service were you in?* Save and Continue LaterFamily & Environment InformationList all of the people residing with you in your household.*NameAgeRelationship Click on the "+" symbol on the right to add information on additional individualsAre there any people with disabilities in your household?*YesNoPlease describe the persons and disabilities*Where do you live?*CitySuburbsRuralFarmWhat type of residence?*HomeCondoApartmentMobile HomeDo you own or rent?*OwnRentHas having a dog living on the premises been discussed with the landlord?*YesNoLandlord Name and Contact Information*Is your yard fenced?*YesNoPlease describe the fence.*(e.g. height, length, material, gaps, etc.)Without a fence, how will the dog be exercised?*Please describe the neighborhood.*(e.g. busy roads, neighbors close by, dogs/cats running free, etc.)Are there many visitors where you live?*YesNoPlease describe the visitors.*How many hours each day will the dog be left alone?*Where will the dog be kept when you are not at home?*Where will the dog be kept during the day when you are at home?*Where will the dog be kept at night?*Do you have other dogs?*YesNoOther Dogs list*BreedGenderAgeSpay/Neuter (Y/N) Are your current dogs inside or outside dogs?*InsideOutsdieNOTE: PAALS Dogs must be raised as inside (house) dogs.Do you have other animals?*YesNoPlease describe your other animals* Save and Continue LaterDog InformationWhat is your experience with dogs?*If you have had pets previously, what became of them?*What gender would you prefer?*MaleFemaleEitherWhat breed would you prefer?*Labrador RetrieverGolden RetrieverGolden Retriever / Lab MixAny BreedSelect colors for your Lab or mix?*BlackBlack & TanYellowAny ColorDo not want a mixWould you consider adopting, at no charge, a dog with a medical problem that may require medication, exercise restriction or other special needs?*YesNoAre you willing to work with a dog that may require further training?*YesNo Save and Continue LaterPersonality MatchDo you have young children who are not living in the household who visit frequently?*YesNoWhat are their ages?*Do you have senior citizens who are not living in the household who visit frequently?*YesNoWhat are their ages?*What are you looking for in a dog?* House Companion Children's Pet Watchdog Competition Obedience (e.g dog shows) Hunting Dog Therapy Dog Running or Jogging OtherCheck all that applyOther - please explain*Check the characteristics that best describe you and the people with whom the adopted dog will be living*Physically active and strongAverage activity and strengthLess active or strongAdditional Comments*Have you in past or are you currently receiving psychiatric treatment?*YesNoPlease give diagnosis, dates and names of providers*If you currently have a psychiatric diagnoses, please describe briefly the symptoms that you experience*When you are having a hard time (anxiety, depression, anger, etc.) what things do you do to get through it?*Do you experience frequent or intense anger?*YesNoPlease describe how this manifests and what strategies you use to manage it.*Have you in the past year had difficulty with alcohol or substance abuse?*YesNoHave you received a diagnosis of TBI?*YesNoPlease describe what symptoms you experience from this*Do you have any physical disabilities or difficulty with mobility?*YesNoPlease describe your physical disabilities or mobility issues* Save and Continue LaterOther Information & AcknowledgementHow did you hear about our Career Change PAALS program?*Please provide the name and phone number of a veterinarian as a reference.*Terms of Service*Career Change Dog AgreementI agree to...Keep the Career Change dog at a healthy weight.Never use a ping or shock collar on the Career Change dog.Never portray or present the Career Change dog as a service or assistance dog.Return the Career Change dog to PAALS if the dog needs to be removed from my home for any reasonIt is the policy of this organization to provide equal opportunities without regard to race, color, religion, national origin, gender, sexual preference, age or disability.By checking the box below, I acknowledge that I have read, understood and agree with the Career Change Dog Agreement. I have read, understood and agree with the Career Change Dog AgreementThe "Submit" button will appear after you check the acknowledgement box.GDPR Compliance* I consent to my submitted data being collected and stored. Save and Continue Later This iframe contains the logic required to handle Ajax powered Gravity Forms.