Service Dogs
The Positive Pit Project
The mission of the Positive Pit Project is to pair a rescue dog with a veteran suffering from PTSD or TBI. The result is saving two lives at one time.
*At this time, we cannot use current family pets.
TO APPLY:
(1) Recognize that you have PTSD or other issues and desire a Service Dog to assist you in daily life.
(2) Talk to your spouse or immediate family about your desire for a Service Dog and ask them for their support. Inform them of some of the ways that you feel a Service Dog would benefit you.
(3) Talk to any medical personnel or case managers you work with to also inform them of your desire for a Service Dog.
(4) Call Megan with the Positive Pit Project with any questions about the application or to schedule a meeting.
(5) The application may be sent via email to [email protected]
(6) Take the appropriate pages to your doctor, therapist, or other medical professional to fill out.
(7)Make sure you are committed to the training process. If you cannot make an appointment, please give a 72 hour cancellation notice.
(8) You will also fill out an adoption application at www.lakecharlespitbullrescue.com/adopt and sign an adoption contract for your dog.
(9) If you have existing dogs in the home, they will be evaluated as well. They may need training sessions to adjust to a Service dog in the household.
(10) Please maintain an open line of communication with Megan and the Positive Pit Project. Let us know immediately if something is not clear or you have questions or concerns.
Megan Manuel Renee Smith
Vice President/Trainer Founder/Director/President
[email protected] [email protected]
337-298-0591 713-854-1895
337-274-3546 personal cell
This is an application only. We have the right to decline applicants, if we feel the applicant’s lifestyle is not suitable for a Service Dog. If you are declined, we will guide you toward other organizations that may be able to meet your needs.
Date:_________________________________
Name:__________________________________________________
Address:________________________________________________
City:______________________________State:___________________Zip:__________
Home Phone Number:__________________________
Cell Phone Number:____________________________
Email Address:________________________________
Date of Birth:_________________________________
Occupation:___________________________________
Are you: Married Single Divorced Separated Widowed
Branch of Armed Services: Army Marines Air Force Navy Coast Guard National Guard
Current status of service: Active Duty Reserve Retired Veteran
Circle all diagnoses that apply: TBI PTSD MST OTHER Are there already animals in the home? _________ If yes, what kind? _____________________
If dogs, are they spayed/neutered?__________________
Confidential Information Form
- Wars/Conflicts in which you fought:_________________________________________
- What years were you deployed?_______________________________________
- Do you feel you have changed since returning from deployment? How so?
- Type of Discharge (if applicable): _____________________________Rank:______________
- Did you have an injury that required hospitalization?________________________
- Do you live alone? __________ If yes, is there a relative or friend nearby?___________
- Are there children in your home? __________ What ages?_________________________
- Do you have physical limitations?
- Do you consume alcohol?________ If yes, how often?:________________
- What is a typical day like for you?
- How would you incorporate the dog into your day?
- How would you exercise your dog?
- Have you had dogs previously?____________ If so what and when?
- What, ideally, would you like for your dog to be able to do for you?
- What comes to mind when you think of a Service Dog?
- In your own words, write how you think having PTSD/TBI Service Dog would allow you to be more independent? Less fearful? Less anxious? Etc.
- Do you feel capable of responding to the challenges of having a PTSD/TBI Service Dog in public places where there might be questions as to its certification and ability to be allowed?
We will be speaking with your spouse, partner, or adult you live with as to whether the dog would be accepted and incorporated into the household. Please provide the name and phone number of the person to contact.
Name:____________________________________________
Phone Number:_____________________________________
Relationship to applicant:_____________________________
Once The Positive Pit Project receives this part of the application, you will be notified. If approved, we will set up an appointment to visit your home to do a home check for the safety of the Service Dog. At this home check, we would like the whole family to be there so that we can discuss what to expect from this program, and what you will be going through, PPP reserves the right to refuse anyone for any reason that will affect the safety and care of the Service Dog
CONFIDENTIALITY AGREEMENT, RELEASE OF INFORMATION, & MEDIA RELEASE FORM
The Positive Pit Project follows all HIPPA regulations as required by the State of Louisiana and the Federal Government. All information received from the applicant and/or health care providers will remain strictly confidential.
This form authorizes any person, health care provider, physician, or organization mentioned in this application to release any necessary information to Lake Charles Pit Bull Rescue/The Positive Pit Project concerning me. This information will be used to evaluate my application for a PTSD Service Dog and its specific training.
I agree that all photographs or video footage taken of me any time during training are the property of The Positive Pit Project and may be used for training, record keeping, fund-raising, and educational purposes.
I have read, understand and will comply with ALL the above.
Name: (please print)___________________________________
Signature:____________________________________________
Date:________________________________________________
The Positive Pit Project representative: Name:________________________________________________
Title: ________________________________________________
Date:_________________________________________________
Witness Signature: ______________________________________
The Positive Pit Project Health Care Provider form
APPLICANT:________________________________________________________
DATE:_____________________________________________________________
NAME OF HEALTH CARE PROVIDER:_________________________________
ADDRESS:___________________________________________________
PHONE NUMBER:___________________________________________________
The Positive Pit Project trains specially selected rescue shelter dogs, or dogs owned by the warrior that have been evaluated and deemed appropriate for the program. These dogs are trained as PTSD, MST, and/or TBI Service Dogs for Wounded Warriors, Active Duty Soldiers, or Veterans of the Armed Forces.
Please complete a LETTER of RECOMMENDATION for the above named Warrior to receive an ASSISTANCE (SERVICE) DOG for the medical diagnosis of PTSD, MST, or TBI on your personal letterhead. This letter may be written by a Psychologist, Social Worker, Therapist, Physician, Physician’s Assistant, Nurse Practitioner, Nurse, or any Medical Professional.
In your letter, please address the following questions:
- The applicant listed above has applied to receive one of these special dogs. Please discuss the applicant’s disability or disabilities. How would this PTSD/TBI Service Dog benefit the applicant?
- To the best of your knowledge is the applicant able to care and provide for a PTSD/TBI Service Dog?
- Has the applicant had a suicide screening? _____ If yes, when?_____________
- Are medications taken by the applicant that would impair or inhibit his/her judgment and abilities to care for this dog?
.
- Do you know of any reason why this person would not be able to care for this dog in an appropriate way?
Your signature will be used as a written prescription for the Service Dog for this person and kept for The Positive Pit Project’s records. Please DO NOT include the diagnosis on the prescription.
Your help in this process is greatly appreciated.
Signature:_______________________________________________________________
Date: _______________________________________________________________________
Please return letter to:
The Positive Pit Project Megan Manuel Vice President and Trainer
419 Contour 337-298-0591
Lake Charles, LA 70605 [email protected]
The Positive Pit Project PERSONAL REFERENCE LETTER
This form must be completed by TWO people from any of the following categories: Physical Therapist, Case Manager, Counselor, Clergy, Co-worker, Social Workers, Psychologists, family member, or friend.
___________________________ has applied to The Positive Pit Project for a Post Traumatic Stress Disorder (PTSD), Military Sexual Trauma (MST) or Traumatic Brain Injury (TBI) Service Dog to help him/her cope with the difficulties associated.
It would be appreciated if you would please provide any information regarding the personality, temperament, and character of the applicant. Please include this information in the following Personal Reference Letter Form.
Applicant Name:_______________________________________
Your Name:___________________________________________
Phone Number:__________________________ Email: ________________________
Address:______________________________________________________________
City:__________________________________State:_________________Zip:_________
- What is your relationship to the applicant?______________________________________
- How long have you known the applicant?_______________________________________
- What support systems does the applicant have?
- To the best of your knowledge how would the applicant benefit from a Service Dog?
- To the best of your knowledge is the applicant able to care and provide for a Service Dog?
Please return this letter to:
The Positive Pit Project
419 Contour
Lake Charles, LA 70605
Megan Manuel, Trainer
337-298-0591
The Positive Pit Project PERSONAL REFERENCE LETTER
This form must be completed by TWO people from any of the following categories: Physical Therapist, Case Manager, Counselor, Clergy, Co-worker, Social Workers, Psychologists, family member, or friend.
___________________________ has applied to The Positive Pit Project for a Post Traumatic Stress Disorder (PTSD), Military Sexual Trauma (MST) or Traumatic Brain Injury (TBI) Service Dog to help him/her cope with the difficulties associated.
It would be appreciated if you would please provide any information regarding the personality, temperament, and character of the applicant. Please include this information in the following Personal Reference Letter Form.
Applicant Name:_______________________________________
Your Name:___________________________________________
Phone Number:__________________________ Email: ________________________
Address:______________________________________________________________
City:__________________________________State:_________________Zip:_________
- What is your relationship to the applicant?______________________________________
- How long have you known the applicant?_______________________________________
- What support systems does the applicant have?
- To the best of your knowledge how would the applicant benefit from a Service Dog?
- To the best of your knowledge is the applicant able to care and provide for a Service Dog?
Please return this letter to:
The Positive Pit Project
419 Contour
Lake Charles, LA 70605
Megan Manuel, Trainer
337-298-0591