K9 Questionnaire Please enable JavaScript in your browser to complete this form.Name *FirstLastAddress *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone *Email *Private Security Contractor or US Military ServiceAre you or did you serve as a private security contractor? *Please select oneYesNoWhat company/companies did you work for? (Please list current and previous employment.) What did your position entail with the private contracting company you worked for?Dates of service? *Are you willing to provide previous and current employment references? *Please select oneYesNoPlease explain any injury or medical conditions received during your service to our country or as a private security contractor. *Are you willing to share your medical documents related to your injury or medical condition? *Please select oneYesNoWould you be willing to meet with one of Shadow Warrior Project's provided mental health professionals? (copy) *Please select oneYesNoWhat is your current military status? *Please select oneActiveRetiredHonorably DischargedDishonorably DischargedNot ApplicableIn what branch did you serve?Are you willing to provide your DD214? *Please select oneYesNoAdditional InformationAre you willing to allow SWP to do a home visit as the first step to being considered to receive a K9? *Please select oneYesNoAre you willing and able to meet the cost requirements associated with owning a service K9? *Please select oneYesNoCosts Include Food, Vaccines and routine care, Dog bed, Dog crate, Lead, Collar, Harness, and more.Are there any children or elderly in the home? Please explain. *Are there other pets in the home? If yes, please explain. *Are you willing to travel to Baden K9 in Canada four times within the first year of your commitment to receiving the K9? (Expenses paid by Shadow Warriors Project in the first year.) *Please select oneYesNoWhat is your current employment situation? Hours worked per week? *Are you willing to sign into a contractual agreement to train solely under the direction of Baden K9 and abide by all instructions, directions, regimens as such under the training of Baden K9? *Please select oneYesNoCan you provide letters of recommendation from a medical professional and personal reference as to why a service K9 would be beneficial to you? *Please select oneYesNoPlease explain why you would benefit from owning a service K9. *Letters of Recommendation Click or drag files to this area to upload. You can upload up to 10 files. If you do not upload your letters now, you must submit letters of recommendation to Mark Geist at swp@shadowwarriorsproject.org within 4 weeks of submitting this questionnaire. NameSubmit