Request a Puppy Raiser Application | Canine Companions Portal

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Please fill out the form below if you are interested in receiving an application to apply to be a Canine Companions Puppy Raiser.

Please note: You must be at least 18 years old to be a volunteer puppy raiser. Those under the age of 18 must have a parent or legal guardian as a co-applicant.

Please see our Puppy Raiser FAQs for more information.

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Applicant

Name Prefix

First Name *

Middle Name

Last Name *

Name Suffix

Nickname

Birth Date *

Month

Day

Year

Gender *

Female

Male

Non-Binary

Prefer not to say

Home Phone Number

Mobile Phone Number

Personal Email Address *

Country *

Street Address *

Street Address Line 2

City *

State/Province *

Postal Code *

Postal Code Suffix

District/County

Case Manager

Regional Center

Application Region

Leave this field blank