Autism Service Dog Application Packet

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.

  • 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.
  • 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.
  • 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.