​​Thank you for your interest in a GOFI service dog.
We service people within 25 miles of Walpole with our Golden Retrievers that we hold to the highest standards of temperament and trainability, and each dog is trained specifically for its recipient’s needs. Our goal is to provide service dogs to those living with physical and psychological disabilities in order to provide greater independence and a better standard of living. GOFI trains dogs to assist with spinal cord injuries, diabetes alert, epilepsy disorders, anxiety disorders, and Post-Traumatic Stress Disorder.  

Please understand that applications are reviewed in the order that they are received. Because we strive to find the best match for each recipient, placement schedules may vary.  You can expect to hear from GOFI within two weeks, at which time an area coordinator will conduct a home visit.  We will then assess whether we have a dog that can meet your needs.

We encourage applicants to call us with any questions or concerns they may have.

Best Wishes,
The GOFI Family

At this time we are only able to consider providing dogs to people living within 25 miles of Walpole, MA 02081.  We apologize for any inconvenience and hope to one day to be able to help more people in need.
RECIPIENT APPLICATION
By submitting below, I hereby acknowledge I have read the above application and I understand that Golden Opportunities for Independence reserves the right to deny service to an applicant for any reason, including but not limited to failure to meet the established criteria for receiving a service dog or requesting services we do not provide. I do hereby agree to hold free from any and all liability Golden Opportunities for Independence and its members and officers. My family, members of my household and myself waive the rights and claims for damages and injuries, which may come from my connection and participation with GOFI
Email:
City: (we only provide dogs to people 25 miles from Walpole, MA)
Street Address:
Person filling out application (if different from Applicant):
Primary Phone Number:
Date of Birth: (we do not provide dogs for anyone under the age of 10)
Height and Weight
Please describe any limitations the applicant experiences in everyday life:
Does the Applicant smoke?
Does anyone in the Applicant's household smoke?
What is the Applicant's normal daily level of activity?
Describe the medical condition(s) for which the Applicant is seeking a service dog:
Does the Applicant use any assistive devices on a daily basis (i.e. wheelchair, crutches, hearing aids)?
If yes, please explain:
Has the applicant ever had an aggressive outburst in which an animal or person was injured?
If yes, please explain:
What type of home does the applicant live in (apartment, condo, house, etc.) and do you own or rent?
Does anyone in the Applicant's home have allergies to dogs?
Please list all people residing in the Applicant's home (name, age, relationship to applicant):
Does the Applicant have a fenced yard?
If no, where and how does the Applicant plan to exercise a dog?
Does anyone else in the household have a disability?
If yes, please explain:
Has the Applicant or anyone in the home ever been convicted of a felony?
If yes, please explain:
Do any animals live in the Applicant's home?
If yes, please list species and ages of animals:
Do the animals in the household get along with other animals?
Does the Applicant have a veterinarian they currently use?
If yes, please provide the name of the clinic and veterinarian:
If yes, please explain:
Is the Applicant employed/school/grade/job title?
Name of Employer:
Employer Phone Number:
How many hours does the Applicant work per day/week?
May we contact the Applicant's employer/school?
Would the Applicant want the service dog to attend work or school with them?
Is the Applicant able to take care of a dog on their own (i.e. walking, grooming, feeding, communicating with the dog, etc.)?
If no, who would help the applicant care for the dog?
Where will the dog stay when no one is home?
Will the dog be allowed to sleep in the Applicant's bedroom, if not where?
How do you plan to provide exercise for the dog? Fenced yard, Leash walk, Tie-out, Allow the dog to run free
How do you plan to address the dog's need to go outside to eliminate? Fenced yard, Leash walk, Tie out, Allow the dog to run free
Can the Applicant afford yearly general veterinary care for a dog ($700-$1000/year)?
Have you ever received a service dog or applied for a dog from another organization?
Name of the organization (if yes):
Outcome of application (if yes):
What tasks would the Applicant like the dog to help them with to make them be more independent?
Is the Applicant's family/household supportive of the applicant having their own service dog?
Please describe the Applicant's current support system:
Who would care for the dog if the Applicant were to be injured, hospitalized, or otherwise unable to care for the dog?
Is the Applicant willing to travel to GRF (323 High St., Walpole, MA) 5 days a week and 2 Saturdays a month for 1 year for training sessions?
Does the Applicant have transportation?
Comments or questions:
Please provide contact information (full name, phone/email, and relationship to applicant) of two non-family personal references:
Applicant Name:
Submit