Guiding Eyes for the Blind Student Application

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We are pleased that you’ve chosen to apply with Guiding Eyes for the Blind. We’re dedicated to finding an ideally matched dog for you based on a deep understanding of your lifestyle. We design our training programs around your individual needs. Your thorough completion of this application will help us determine if a Guiding Eyes guide dog is the right choice for you and how we can best work with you to achieve your goals, thank you!
 Non-Discrimination and Privacy Statement

Guiding Eyes for the Blind does not discriminate against any applicant for admission to our guide dog programs based on race, religion, color, national origin, ancestry, age, marital status, gender or any other factor prohibited under local, state or federal laws.  Providing race and/or ethnicity information is optional and used for statistical purposes only.  As part of the application process, Guiding Eyes for the Blind, Inc. may conduct reference and criminal background checks on all applicants. Contact the Admissions Department if you would like to provide us with background information that will assist in these areas.  Any information collected during the application process will be kept confidential.

Instructions 

Your complete answers to the application questions will help Guiding Eyes for the Blind get to know you and help us to assess your ability to successfully train and use a guide dog. Information requested includes your contact details, history of Orientation & Mobility Training plus any Guide Dog training, a description of your routine travels, your expectations/limitations and a health summary.  An * at the beginning of a word means the information is required.  Once you begin answering questions on the application and want to save the information you have entered, there is a "save your responses and resume editing later" checkbox at the top of the screen, you must have an email address to save your responses and resume editing later. 

 Upon completing the application click the "Continue" button at the bottom of the screen.  A "Please Review your responses and Confirm" screen will appear.  At the bottom of the screen you have options to Make a correction, Print, or Confirm.  Once you click Confirm you can no longer make changes. After confirming, a Release of Information Form will appear. This form authorizes Guiding Eyes for the Blind’s request for your professional service information from Other Guide Dog Schools (if attended) and/or Orientation and Mobility Training. Typing your name and clicking the 'type your name to sign' checkbox, generates an electronic signature. You must have an email address to receive a validation email to confirm your signature.

The application begins on the next page.  Please acknowledge you have read and understand the Non-Discrimination and Privacy Statement by clicking the Next Page button at the bottom of this screen.

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Legal Name
As noted on ID or passport
As noted on ID or passport
 Please review our eligibility requirements below:   
1.  Walk outdoors regularly unaccompanied and independently using a white cane or guide dog.
2.  Can be responsible for the care of a dog.
3.  Have had Orientation and Mobility training
4.  Are legally blind.
5.  Are over 16 years of age (If you are 15, you are welcome to apply if you will be turning 16 during the application process).
6.  Live in the United States, Canada or Puerto Rico (residents of other countries should visit the International Guide Dog Federation).
GEB Admissions Only

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Contact Information
 
Home Address
Enter name, relation and phone number of person(s) to contact in case of emergency


How do you prefer to receive written communications?
Personal Information
Name you like to be called
Enter four digit year, Ex: 1/3/2001, not 1/3/01





References
Please provide contact information for your Orientation and Mobility instructor so that we can contact them as a reference. If you have not worked with them in the past 5 years, this section is optional.
Phone of person giving reference
Address of person giving reference
 Please provide us with the names and contact information for two personal references that aren't related to you.
Personal Reference 1

Personal Reference 2

Other Guide Dog School History



Current Travel in Home Area - Please provide us with descriptions of up to the three routes you travel most frequently
Route 1

Route 2
Daily, 2xweek, weekends only

Route 3
Daily, 2xweek, weekends only

Additional Questions





Health Questions







Programs Offered

Residential Program: Three-week program held at our training center in Yorktown heights, NY. Students have their own room and bath, equipped with a TV and refrigerator.  Training begins on our campus and progresses to nearby towns and cities.  Eventually, students train in custom locations which can include New York City to individually prepare them for their home environment.

 

Home Training Program: In order to qualify for Home Training, you must demonstrate a reason why you cannot attend our Residential Program. For example: Child Care, Work Obligations, Caring for an Elderly Parent, etc.  Our Home Training program may be an option for both first-time and repeat guide dog users.  Training will be conducted in your home environment for 10-15 days depending your experience working with a Guide Dog.


Specialized Training Program: Students can be served through the Residential or Home Training Programs.  Specialized Training instructors design training programs suited to accommodate each student's individual needs.  These instructors are also trained in tactile American Sign Language to communicate with those who are DeafBlind.

 

ACTION Program – for experienced Guide Dog users: If a student is already a guide dog user, he or she can consider the ACTION Program.  ACTION students train for ten days at Guiding Eyes, and then return home for several days of training with a Guiding Eyes instructor.




Congratulations, you are at the end of the application!  To ensure you do not lose the information entered, if you have not already done so, tab to the 'Save my progress and resume later' checkbox at the bottom or top of the screen, You will be asked to enter your email and to create a password, then click 'Save' and click 'Resume this form now'. When you are ready to Submit this application, find the Submit button at the bottom of the screen.  Once you press submit, if no errors exist, scroll to the bottom of the page, there are three options; Confirm, Make a Correction, or Print a Copy.  Press Confirm, Admissions will receive your application. When you press submit, if you receive an error and cannot locate the problem, as long as you have clicked the 'Save my progress and resume later', Admissions will be able to help identify any issues.  Please continue to read below before clicking Submit.


There is no cost to our training program.  Graduates can expect to pay $80-$100 per month in dog food costs.  We provide a stipend to every graduate of $500 per calendar year to cover basic veterinary care for their working guide dog (this does not apply to retired guide dogs). Graduates are responsible for veterinary costs that exceed this stipend.  Keep in mind as well that, like people, most dogs require more veterinary care as they age. 


Upon submission of this application you will receive an email with additional forms including a medical form for all applicants and a vision report for first time applicants only. These forms should be filled out by your doctor's please print them out or forward them. We are happy to mail them to you if you prefer to have them sent please contact the Admissions Department at 914-243-2222 or e-mail admissions@guidingeyes.org.


It is important that you return any additional forms to us as soon as possible so that we can present your application to the Admissions Committee for review.


Completing this application places neither Guiding Eyes for the Blind, Inc, or yourself under any obligation.  Any applicant denied admissions may appeal the decision through our appeals process or subsequently reapply. 


Thank you and we look forward to working with you!
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