Therapy Dogs - New Handler Application - Mental Health and Wellness - Wellness - Current Students

Owner Information

Name*

First Last

Carleton Email*

Enter Email Confirm Email

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Affiliation with Carleton (include office/department):*

As an employee, are you in good standing with Carleton University?*

Yes
No

Have you ever been placed under corrective action at Carleton University?*

Yes
No

When were you placed under corrective action?

Veterinary Information

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

How many years have you been with this clinic?*

Pet Information

Name*

First

Breed*

Age + Birthday*

Example: 4, Feb 19

How long has your dog lived with you?*

Please indicate if your dog is male or female:*

Male
Female

Please indicate if your dog is spayed or neutered:*

Spayed
Neutered

Has your pet completed any type of obedience training? If yes, please briefly mention them below:

Application Questions

Does your dog have a special story? What makes you feel they may be well suited to therapy work?*

Are there any specific accommodations that you need in order to participate in the program?*

Are you willing to participate in additional outreach activities such as campus/community events?*

Yes
No

Are you and your dog willing to participate in media requests if asked? Opportunities may include, but are not limited to: printed media, social media, and other media outlets as requested.*

Yes
No

My dog and I would be most interested in (check all that apply):*

Small groups of 1-4 in my office setting (consistent weekly commitment)
Meet-and-greet style visits in key areas of campus (larger volumes of students circulating)
Meet-and-greet style as requested by departments to assist in driving student traffice to services
Attending special events by request
After-hours events by request

Mental Health and Wellness