Handle with Care Community Facilitator Application

First and Last Name*

Email Address*

Phone*

Complete Home Address*

Website/Social Media

Do you have a valid Driver's License?*

Yes
No

Are you willing to drive to meet with clients?*

Yes
No

Provide all relevant educational history and work experience*

Reference 1*

Name Street Address City State ZIP Code

Phone

Reference 2*

Name Street Address City State ZIP Code

Phone

Reference 3*

Name Street Address City State / Province / Region ZIP / Postal Code

Phone

Availability-days, times, frequency

How did you hear about us?*

Why are you interested in Volunteering as a Community Facilitator with Canine Assistants?*

If you have experience working with dogs, what has been your biggest challenge in that work?*

If you have experience working with customers/clients, what has been your biggest challenge in that work?*

It is okay for people to use animals as they see fit*

Strongly Agree
Agree
Disagree
Strongly Disagree

Please explain your answer*

Order is important to me*

Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree

It is normal for people to talk to their dogs, even in public*

Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree

Dogs are thinking beings*

Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree

Dogs are emotional beings*

Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree

I am patient with young children*

Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree

Chaos bothers me*

Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree

Dogs should sleep in bed with their people*

Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree

Barking dogs bother me*

Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree

Dog should never jump on people*

Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree

Service dogs dogs should always be obedient to humans*

Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree

I like being around dogs, even when they aren't well mannered*

Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree

Describe what you believe is the ideal service dog*

Have you ever had a dog? If so, describe your experience. Share something you wish you had done differently with your dog(s).*

What is the difference between a well-mannered dog and an obedient dog?*

Before criticizing someone, I try to imagine how I would feel in their place. *

Not at all like me
Rarely like me
Sometimes like me
Often like me
Always like me

When I see someone being taken advantage of, I feel kind of protective of them*

Not at all like me
Rarely like me
Sometimes like me
Often like me
Always like me

If a dogs’ physical needs are met, what do dogs need to thrive as working (or non-working) dogs?*

If selected, would you be willing and able to keep a dog in your house for 2 nights to 2 weeks at a time?*

If you have been working with a dog for a year or more, how do you think you will cope with having to say goodbye to the dog forever when he/she has completed the educational objectives?*

Please list any pets you have, including age, gender, and species*

If selected, are you willing to submit a criminal background check?*

Yes
No