In order to complete the Autism Service Dog Packet, please read the instructions below:
ALL ITEMS listed below need to be printed, filled out completely and returned together. Incomplete packets will not be accepted or reviewed.
- Application Packet Cover Sheet – print and complete one
- Characteristic and Behavior Statement – print and complete one
- Photo (include a photo of you child alone or with family members)
- Video – You will need to submit approximately 15 minutes of video showing the child at normal play, stemming and also during a meltdown. This can be done at home and in other environments.
- Family Commitment Letter – print and complete one
- Family Commitment Statement on School – print and complete one
- Prescription – You will need to supply a valid prescription or note from a primary physician for the service dog.
- Activity Log (5 days) – You will need to print and complete 5 of these forms. We ask that you be as detailed as possible and include all pertinent information. If possible, have the log forms represent a weekend and three week days.
- Current School Policy in Regards to Service Animals – If your school does not have a policy in regards to service dogs, please submit a letter stating that there currently is not school policy.
- Vet Reference Form – print and complete one
- Reference Letters – Please include in your packet three reference letters in regards to whether the applicant would be a good candidate for a service dog. One letter should be from a therapist or ABA on office letterhead. All reference letters should be sealed in an envelope and signed across the seal.
Any further information that you would like to submit is welcome and will be used in considering your application packet.