Serving our Veterans who served us all! www.northwestbattlebuddies.org Our Mission Honor our combat veterans who have been diagnosed with PTSD by providing professionally trained service dogs at no cost to them in order to help restore their independence Partnering with state and local community organizations, to not only help fund the program, but to help honor these American heroes In recent years we have come to recognize as our nation s veterans age and our wounded warriors return home from combat, that a greater need for companion service dogs is evident. These special service animals help save lives One Northwest Battle Buddies team at a time by providing the special support that is necessary to help our heroes gain their independence in a changing world. These dogs assist the veteran in their daily lives allowing them to navigate life with dignity and self- reliance. While the wounds of PTSD are not readily visible, they are debilitating. Northwest Battle Buddies trains and supplies dogs to returned combat veterans whose disabilities are less obvious, at no cost to the veteran. In order for a dog to qualify as a Northwest Battle Buddies candidate for training, it must meet criteria set forth by our Training Directors. All dogs must be healthy, of good temperament, less than 2 years of age, and meet the training standards of Northwest Battle Buddies. The dogs and veterans will be paired according to the individual characteristics and requirements of the veteran as was ascertained during the application and interview process. At the time of the initial interview at the Northwest Battle Buddies training facility please bring the following: Pictures of the inside and outside of your house, yard, any gates or structures on your property. Verification of income (current)
Training will take place in a variety of real-life situations, with personalized training provided and monitored by Northwest Battle Buddies training team. All dogs are currently housed and trained at our training facility, Man s Best Friend, in Battle Ground, Washington. Upon completion of the Northwest Battle Buddies training program, the teams will be certified and will go home together to begin their lives as a certified Northwest Battle Buddies team. They will have mastered the techniques to be a successful team in a partnership of independence. Ongoing training, post Northwest Battle Buddies team certification, will be provided in the form of additional training and follow-up as required at no cost to the veteran. The admissions process starts when a prospective applicant contacts us and indicates they are interested in obtaining a service dog. You may fill out our application online and then print it to submit with the other need materials from our website www.northwestbattlebuddies.org. If you have questions or concerns about whether the commitment of a service dog is right for you, your doctor or therapist that is working with you may be able to guide you in this regard. In addition to your therapist, we can put you in touch with one of our Northwest Battle Buddies teams for a first-hand account of the daily trials and rewards that the commitment to your service dog can bring to you. Your file is considered active once Northwest Battle Buddies has received the complete packet (i.e.: personal and professional recommendations, letter from Doctor or therapist, on official letterhead medical records, discharge orders). You will receive messages via e mail, or U.S. Postal service (when email is not possible) to apprise you of the status of your packet completion. You will continue receiving update letters until all documentation has been received and the folder is complete. Once the applicant s folder is completed and all information has been reviewed it will be date stamped and placed in a file by order of receipt. Interviews will take place at the Northwest Battle Buddies headquarters in Battle Ground, Washington, once there our Training Directors will pair your dog with you. Once matched with your service dog, training sessions begin and are tailored to the individual team s requirements. Training for the team will continue until certification is complete and you become a Certified Northwest Battle Buddies Team! In the event that an applicant is not chosen for the Northwest Battle Buddies program, and we cannot provide a service dog for them (i.e.: applicant has not met criteria set forth, living situation etc.). Northwest Battle Buddies will provide a written explanation of denial. The qualification process continues after the application is completed. Continued Qualification consists of the applicant s accountability to the Training process and the
Northwest Battle Buddies Service Dog. At any time if treatment of the dog is in question the Applicant will be dismissed from the Northwest Battle Buddies Program. The next steps are case by case and may involve a suggestion that the applicant return once issues have been resolved. - Who is eligible to receive a service dog? - How much does a service dog cost? - I have PTSD. What can a Northwest Battle Buddies dog do for me? - I am still on active duty. Can I get a service dog? - What kinds of dogs are used? - What kind of training do the dogs go through to become a companion service dog? - How do I apply for a service dog? What is the application process? - How long does it take to get a dog? - Where does the training take place? - What types of follow up services are available once I return home? - What is the average working life of a service dog? - How long is the training for my new service dog with me? Who is eligible to receive a Northwest Battle Buddies Service Dog? Any returned COMBAT VETERAN who has been HONORABLY discharged from the U.S. armed forces, and some active duty military personnel who have been certified by their rehabilitation specialist that they require the assistance of a service dog for help with their PTSD. How much does Northwest Battle Buddies service dog training cost? There is no cost to the combat veteran. Once you have been paired with your dog, you will be responsible for all the food and basic medical care. Your dog will become your responsibility. I have PTSD. What can a Northwest Battle Buddies dog do for me? A Northwest Battle Buddies dog can aid you in many areas of your life. The dog can and will be your constant companion in public and/or social situation. Your Battle Buddy will be there to "watch your back" and let you know if someone is getting too close or behind you. The dog can help provide balance and perform small tasks to assist in everyday life, such as waking you from nightmares. The dog provides emotional support and companionship which will aid in your return to independence, creating more of a reason to keep moving forward toward a healthy life. Just to name a few.
I am still on active duty. Can I get a service dog? Your commanding officer must approve the orders that will allow us to begin the training. We do place service dogs with qualified active duty personnel. What kinds of dogs are used for Northwest Battle Buddies? We are not breed specific, we receive dogs from local shelters or by community donation. The dogs are young and mentally and physically healthy. A local veterinary clinic provides a health exam and certification. The criteria for a Northwest Battle Buddies dog is: sociable, confident and 2 years of age or less. Each service dog is evaluated and paired with the veteran according to the individual s unique requirements. What sort of training do the Northwest Battle Buddies go through? Each service dog is trained for individuals particular requirements, including passing Canine Good Citizen Test and Public Access Test How do I apply for a Northwest Battle Buddies dog? You may apply directly to Northwest Battle Buddies, however, we urge you to contact your local VA rehabilitation specialist to ensure that you receive all the services you re entitled to, and that there is a coordination of services. What is the application process? You will be required to fill out the application and provide us with the requested information. Once we have received your application, you will go on the waiting list and be interviewed when it is time to pair with your Battle Buddy. How long does it take to get the Northwest Battle Buddies service dog? Northwest Battle Buddies dogs are trained to navigate the outside world and your particular lifestyle, as well as their other special services. Each dog takes 6-8 months to finish. Upon the approval of your application, you will receive a letter of completion. Once there are dogs to be paired up the applicant will be matched. The waiting period is based on availability and order of applicants waiting list. Where does the Northwest Battle Buddies dog receive training? Services are available at a variety of locations. Northwest Battle Buddies dogs are specifically trained to navigate everyday life situations. Training will be conducted not only at the Northwest Battle Buddies professional training facility but also in the outside world in places such as: restaurants, public transportation, shopping malls, grocery stores, theaters and anywhere the veterans may frequent. What is the average life of the Northwest Battle Buddies service dog?
The service dog s career depends on how active you are. You can expect the dog will have eight to ten good working years. What sort of follow-up services are available once I return home? Once you have gone through the training with Northwest Battle Buddies, you are eligible for a lifetime of aftercare. Should you require follow-up training, our staff will arrange to work with you on any questions or concerns you might have in a prompt and professional manner, which may include a home site visit. We recognize the sacrifices that you have made for our nation. We will do our part to see that your Northwest Battle Buddies service dog will help you to lead an active, independent life. How long is the training for my new service dog with me? You will need to plan six weeks of training sessions in various locations with your new service dog. It will be necessary to ensure that you and your dog are working well together, and that you have a full understanding and knowledge of how to work with your new companion while abiding by the guidelines set forth by the ADA and Northwest Battle Buddies. Being paired with a service dog is a life-changing experience. Along with this gift comes much responsibility and challenge. It involves hard work and commitment for the life of your service dog and can involve frustration since you are working with a live animal that can make mistakes. Before you apply for the Northwest Battle Buddies program, read through this application and consider the ways a dog will impact your life. Some disabilities are apparent; others are not visible to the general public. The presence of a service dog will immediately catch others' attention and make it known that you have a disability. Many people will ask you about what your dog does for you, others might stare. Many people love dogs and you will find that you are welcomed by them; you may even feel like a celebrity sometimes. But, on the downside, you can count on being stopped many places you go by people asking questions and making comments about your dog. You need to strongly consider how you will respond to this level of attention.
You will have an intense training period in which you will accompany Northwest Battle Buddies trainers into public areas and social situations as you learn to effectively work with your service dog. This can be nervewracking and very tiring. Once you take your Northwest Battle Buddies Dog home, you must continue to work every day for the rest of your service dog s life. You will spend 24 hours a day with your dog, and devote much of your time building your working relationship. Do you have the time and patience needed? If you are planning to start a new job, have a baby, start school, or any other long term commitment, you may want to put off the decision to receive your Northwest Battle Buddies dog until a later time. You need to be sure that those you live with or those you come in contact with on a daily basis are accepting and/or supportive of you receiving and caring for a service dog. Talk to those in your home, workplace, etc and get their feedback. Remember this is a lifelong commitment. Although a service dog can help you to integrate and adjust to your civilian life, you will be faced with challenges. You have a legal right to have a service animal with you at all times; however, you can expect to be challenged about that from time to time.
Northwest Battle Buddies DEMOGRAPHICS Serving our Veterans who served us all! www.northwestbattlebuddies.org Application for Service Dog MUST BE A COMBAT VETERAN TO APPLY Are you active military? Yes No Name: Date of Birth: Address: City: State: Zip: Cell/Home #: Work #: E-mail address: Referred to Northwest Battle Buddies by: PHYSICAL HISTORY Please describe any physical limitations or limiting medical conditions: Do you have any hearing loss? Yes No Degree of hearing loss: Are you visually impaired? Yes No Degree of visual loss: Page 1 of 2
Describe your routine which includes travel: How would you rate your confidence as an independent traveler? SERVICE DOG INFORMATION Have you previously used an assistance dog? Yes No Are you able to adequately maintain a service dog? Yes No (Food and equipment cost approximately $50.00/month plus veterinary care.) Northwest Battle Buddies requires at the time of application that you comply by initialing the following: I am and have been clean and sober for at least one (1) year prior to applying I have provided a copy of my DD214 indicating an Honorable Discharge if not active. I have provided proof that I have stable housing and a source of income. I have a doctor's referral/or therapist referral on official letterhead. I have provided three letters of personal references (can be friends or family). I will provide a Release of Information (ROI), naming NWBB as organization. I am able to provide a clean and safe environment for my Service Dog. I have provided a Personal Statement (what would a battle buddy mean to me). I have provided pictures of the inside and outside of my residence. I understand that completing this form places neither myself nor Northwest Battle Buddies under any obligation, but assists Northwest Battle Buddies in determining my eligibility for training. Northwest Battle Buddies does not discriminate against any applicant based upon race, color, religion, national origin, ancestry, age, marital status, gender, or any other factor prohibited under local, state or federal laws. Your application will be held current for one year, if we have not received the required documents in that time frame we will consider your application status disqualified. Any applicant denied admission may subsequently re-apply and be reconsidered without prejudice. Signature Page 2 of 2 Date
Northwest Battle Buddies Serving our Veterans, who served us all! www.northwestbattlebuddies.org Audio/Video/Photograph Release Form Often during events or training sessions, photos are taken of dog /handler teams. On the occasion that family members or people attending the events are in the photos or videos, Northwest Battle Buddies reserves the right to use footage as promotional material or advertisement. I authorize northwest battle buddies, through its employees and agents, to record audio, video, and/or to photograph me (or my minor child) and to use and reproduce all audio clips, video clips, and/or photographs to advertise, promote or demonstrate programs and services in printed materials and on the internet without further notice to me and without compensation. This is to certify that, I, or, as a parent/guardian with legal responsibility for the subject, do consent and agree to the release as provided above. Signature Date
TO: DEPARTMENT OF VETERANS AFFAIRS (Print or type name and address of health care facility) REQUEST FOR AND AUTHORIZATION TO RELEASE MEDICAL RECORDS OR HEALTH INFORMATION PATIENT NAME (Last, First, Middle Initial) OMB Number: 2900-0260 Estimated Burden: 2 minutes Privacy Act and Paperwork Reduction Act Information: The execution of this form does not authorize the release of information other than that specifically described below. The information requested on this form is solicited under Title 38, U.S.C. The form authorizes release of information in accordance with the Health Insurance Portability and Accountability Act, 45 CFR Parts 160 and 164, 5 U.S.C. 552a, and 38 U.S.C. 5701 and 7332 that you specify. Your disclosure of the information requested on this form is voluntary. However, if the information including Social Security Number (SSN) (the SSN will be used to locate records for release) is not furnished completely and accurately, Department of Veterans Affairs will be unable to comply with the request. The Veterans Health Administration may not condition treatment, payment, enrollment or eligibility on signing the authorization. VA may disclose the information that you put on the form as permitted by law. VA may make a "routine use" disclosure of the information as outlined in the Privacy Act systems of records notices identified as 24VA10P2 Patient Medical Record - VA and in accordance with the Notice of Privacy Practices. You do not have to provide the information to VA, but if you don't, VA will be unable to process your request and serve your medical needs. Failure to furnish the information will not have any affect on any other benefits to which you may be entitled. If you provide VA your Social Security Number, VA will use it to administer your VA benefits. VA may also use this information to identify veterans and persons claiming or receiving VA benefits and their records, and for other purposes authorized or required by law. The Paperwork Reduction Act of 1995 requires us to notify you that this information collection is in accordance with the clearance requirements of section 3507 of the Paperwork Reduction Act of 1995. We may not conduct or sponsor, and you are not required to respond to, a collection of information unless it displays a valid OMB number. We anticipate that the time expended by all individuals who must complete this form will average 2 minutes. This includes the time it will take to read instructions, gather the necessary facts and fill out the form. ENTER BELOW THE PATIENT'S NAME AND SOCIAL SECURITY NUMBER IF THE PATIENT DATA CARD IMPRINT IS NOT USED. SOCIAL SECURITY NUMBER NAME AND ADDRESS OF ORGANIZATION, INDIVIDUAL OR TITLE OF INDIVIDUAL TO WHOM INFORMATION IS TO BE RELEASED VETERAN'S REQUEST: I request and authorize Department of Veterans Affairs to release the information specified below to the organization, or individual named on this request. I understand that the information to be released includes information regarding the following condition(s): DRUG ABUSE ALCOHOLISM OR ALCOHOL ABUSE TESTING FOR OR INFECTION WITH HUMAN IMMUNODEFICIENCY VIRUS (HIV) SlCKLE CELL ANEMIA INFORMATION REQUESTED (Check applicable box(es) and state the extent or nature of the information to be disclosed, giving the dates or approximate dates covered by each) COPY OF HOSPITAL SUMMARY COPY OF OUTPATIENT TREATMENT NOTE(S) OTHER (Specify) PURPOSE(S) OR NEED FOR WHICH THE INFORMATION IS TO BE USED BY INDIVIDUAL TO WHOM INFORMATION IS TO BE RELEASED NOTE: ADDITIONAL ITEMS OF INFORMATION DESIRED MAY BE LISTED ON THE BACK OF THIS FORM AUTHORIZATION: I certify that this request has been made freely, voluntarily and without coercion and that the information given above is accurate and complete to the best of my knowledge. I understand that I will receive a copy of this form after I sign it. I may revoke this authorization, in writing, at any time except to the extent that action has already been taken to comply with it. Written revocation is effective upon receipt by the Release of Information Unit at the facility housing the records. Redisclosure of my medical records by those receiving the above authorized information may be accomplished without my further written authorization and may no longer be protected. Without my express revocation, the authorization will automatically expire: (1) upon satisfaction of the need for disclosure; (2) on (date supplied by patient); (3) under the following condition(s): I understand that the VA health care practitioner's opinions and statements are not official VA decisions regarding whether I will receive other VA benefits or, if I receive VA benefits, their amount. They may, however, be considered with other evidence when these decisions are made at a VA Regional Office that specializes in benefit decisions. DATE (mm/dd/yyyy) SIGNATURE OF PATIENT OR PERSON AUTHORIZED TO SIGN FOR PATIENT (Attach authority to sign, e.g., POA) FOR VA USE ONLY IMPRINT PATIENT DATA CARD (or enter Name, Address, Social Security Number) TYPE AND EXTENT OF MATERIAL RELEASED DATE RELEASED RELEASED BY VA FORM JUL 2013 10-5345 USE EXISTING STOCK OF VA FORM 10-5345, DATED MAY 2005.