Common use of Service Information Clause in Contracts

Service Information. When did you join the armed forces? Are you discharged from the armed forces? What type of discharge did you receive: Highest rank achieved: In which theater(s) of conflict and campaigns did you serve? Please describe your service related injuries and the circumstances under which they occurred: How would a service dog help you better cope with or manage your disability and to make you more independent? How do you think life would change if you had a service dog? Please describe how you will handle the following areas of dog care: Feeding: Grooming: Toileting: Your absence during an emergency: Family/friend involvement: Dog behavior problems: Fleas, ticks, heartworm: Financial expenses upon receiving the dog: What specific difficulties might you have with a physically rigorous, emotionally demanding training program? What modifications can you make to accommodate this training? What modifications must the training program make to accommodate your specific difficulties? How will you handle costs and time required to attend the required training? Is there and other information you wish to voluntarily provide to help us develop a better service dog training regimen for a dog being trained to assist you? Any Additional comments or thoughts that you would like to provide to RFI in the consideration to receive a service dog: Please sign below if you consent to Retrieving Freedom Inc sharing contact information regarding third party research to use of Service Dog. This is only to share your contact information. You can decline or withdraw at any time. I agree to allow RFI to share my contact information: ______________________________________________ I do not want my contact information to be shared by RFI: ________________________________________ By signing my name below, I attest that all the information I have provided is true to the best of my knowledge, up-to-date and accurate and I hereby authorize RFI to evaluate your application Signature: Date:

Service Information. When did you join the armed forces? Are you discharged from the armed forces? What type of discharge did you receive: Highest rank achieved: In which theater(s) of conflict and campaigns did you serve? Please describe your service related injuries and the circumstances under which they occurred: How would a service dog help you better cope with or manage your disability and to make you more independent? How do you think life would change if you had a service dog? Please describe how you will handle the following areas of dog care: Feeding: Grooming: Toileting: Your absence during an emergency: Family/friend involvement: Dog behavior problems: Fleas, ticks, heartworm: Financial expenses upon receiving the dog: What specific difficulties might you have with a physically rigorous, emotionally demanding training program? What modifications can you make to accommodate this training? What modifications must the training program make to accommodate your specific difficulties? How will you handle costs and time required to attend the required training? Is there and other information you wish to voluntarily provide to help us develop a better service dog training regimen for a dog being trained to assist you? Any Additional comments or thoughts that you would like to provide to RFI in the consideration to receive a service dog: Please sign below if you consent to Retrieving Freedom Inc sharing contact information regarding third party research to use of Service Dog. This is only to share your contact information. You can decline or withdraw at any time. I agree to allow RFI to share my contact information: ______________________________________________ I do not want my contact information to be shared by RFI: ________________________________________ By signing my name below, I attest that all the information I have provided is true to the best of my knowledge, up-to-date and accurate and I hereby authorize RFI to evaluate your application Signature: Date: