Request Application

Ready to Apply?

Get an Application

Complete this form to receive an application to be partnered with an assistance dog. We will contact you or mail an application to you within a week.
  • This is the address where we will send your application.
  • We don't require an email address but it will help us get in touch with you if we have any problems getting an application to you, so we highly recommend you provide one.
  • If you are not requesting this application for yourself, please let us know who it is for.
  • EENP does not place guide dogs, hearing dogs, or psychiatric service dogs at this time. If you need one of these types of assistance dog, please visit Assistance Dogs International to find an organization making those placements in your area.
  • Typical tasks include alerting to high or low blood sugar, retrieving dropped items, getting help from another person, or providing balance support.
  • Please use this space to provide additional information that may be of use to us as we send an application to you. If you have questions about the application process and whether EENP would be able to place an assistance dog with you, please email us with your questions at info@eenp.org or call us at 919-408-7292. We are unable to respond directly to comments in this form.
  • We generally add contact information to our email and mailing list in order to be sure you receive invitations to graduations and events. However, if you would prefer that we not use your contact information for anything other than direct contact about the application process and your request, please let us know here. Regardless of your choice here, we NEVER sell or rent your contact information.