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OccuPaws OCI Volunteer Coordinator
P.O. Box 45857
Madison, WI 53744
Phone : 608-772-3787
FAX :866-854-3291
E-Mail :

VOLUNTEER TRAINER APPLICATION

For the Oshkosh Correctional Institution(OSCI)Service Dog Program

Contact Information

Name (s) F/M/L / Birth Date
Address
City, State Zip / Driver’s License Number
Home Phone / Work Phone / Cell Phone
E-Mail Address
Primary handler?
Employer 1 / Position
Employer 2 / Position

References:

# / NAME / Relationship / Phone/e-mail
1
2
3

All applicants will be subject to a criminal background check.

All applicants are subject to the Polices of the Department of Corrections / Oshkosh Correctional Institution. Do you agree to follow the Policies of the Department of Corrections / Oshkosh Correctional Institution?

YES NO

Dog Training Experience:

Dog Experience: Check ALL that apply

Obedience Shows Conformation Shows Hunt Tests Field Trials
Tracking Agility Rally Therapy dog
Canine Good Citizen Search and Rescue Scent/Police Work Guide/Assistant Dog
Hunting Obedience Classes Crate Training Potty Training

Describe your experiences with the items selected above:

Describe the equipment that you have used:

Flat Collar Gentle Leader Infi8 Head collar Easy Walk Harness
Tracking Harness Training collar Prong collar Clicker

Describe your experiences with the items selected above:

People Training Experience:

Please list the type of “people” training that you have done previously. What classes have you taught? (If any.)

Obedience ClassConformation ClassTracking Class Agility Class

Rally Class Therapy Dog ClassCanine Good Citizen Search and Rescue

Scent/Police Work Harness Work (Guide) Service Dog Class Professional Dog Trainer

Describe your experiences with the items selected above:

Describe the Type of training that you prefer:

Positive Re-enforcement with Treats
Negative Re-enforcement

Describe your experiences with the items selected above:

When you are working with the inmates to train the dogs, you will come in direct contact with inmates within the Oshkosh Correctional Institution. You are required to accept all rules and regulations that the DOC requires, and further to attend orientation sessions as conducted by the DOC and the Occupaws/Pathways to Hope programs.

Are you willing to accept this stipulation? YES NO

Please describe your availability: Please choose all that apply.

Monday TuesdayWednesday Thursday Friday Saturday Sunday

8:00 am – 12:00 pm12:00 pm – 5:00 pm

I can provide transportation for a dog from the OSCI to the veterinarian on an emergency basis.

I can provide transportation for a dog from theOSCI to the veterinarian on a scheduled basis.

I can check inventory of program supplies within the OSCI (Dog Food, crate sizes, collars, etc.)

Agreement and Signature

By submitting this application, I (we) affirm that the facts set forth in it are true and complete. I (we) understand that if I (we) am/are entrusted to be a Oshkosh Correctional Institution Program Volunteer Trainer, any false statements, omissions, or other misrepresentations made by me (us) on the application may result in my (our) immediate dismissal from the Program

Signed this ______day of ______, ______by

______

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