Apply or Nominate

Begin a Golden Connection

Submit a preliminary application for yourself, or nominate someone else with their knowledge and consent. This form collects only what we need for an initial review.

Your privacy matters. We do not request medical records, diagnoses, Social Security numbers, or financial-account information in this initial form. If sensitive information becomes necessary later, we use an appropriately secure and private process. Information concerning minors and foster youth is handled with extra safeguards.

I am…

Applying for myselfI am the prospective recipient.Nominating someone elseWith their knowledge and consent.

Applicant or nominee name *

Applicant age range *

Parent or guardian details (if required)

General location *

Contact email *

Contact phone

Recipient category *

General reason for requesting a companion dog *

Household members *

Current pets

Housing situation *

Permission to keep a dog? *

Preferred dog type, if any

General care capacity *

I understand that submitting this application does not guarantee selection or placement, and that eligibility, matching, timing, and availability depend on the foundation's resources and placement process. *I consent to the foundation's Privacy Policy and to being contacted about my request. *

Protected against spam. We use this information only to conduct a preliminary review.