First Name

Last Name

Street Address

Street Address 2

City

State

Zip

Email Address

Phone

Name of Company (if applicable)

Business Website (if applicable)

Business Facebook Page (if applicable)

Education (List highest level of degree obtained e.g. High School, Undergraduate, Technical/Vocational Schools):

Employment Prior to Dog Training (List previous employer, position and dates of employment):

Years of Dog Training:

Where did you acquire your training skills? (e.g., self-taught, training school or academy (please identify facility and dates attended)):

If you have not attended any seminars, courses or presentations, please state reason(s):

Certification or Accreditation (CPDT, KA, Training School Certification/honors, memberships):

Professional Affiliations (APDT, IAABC, etc):

Training Background Describe your experiences and other areas of involvement with dogs (volunteering in shelters, private in home training, board and train facility, etc):

Have you performed temperament assessments on dogs at shelters? Have you performed temperament assessments on dogs at shelters? Yes No

If yes, what assessments did you utilize to temperament test the dogs you evaluated (Assess-A-Pet, SAFER, etc):

Are you familiar with CGC requirements? (are you an evaluator or has your dog passed the CGC test):

What is your knowledge/experience with learning theory? What is your knowledge/experience with learning theory? Very Good Good Average Poor No History

What is your experience in using shaping to teach a new behavior? What is your experience in using shaping to teach a new behavior? All of the time Most of the time Sometimes Rarely Never

What is your preferred method for eliminating an unwanted behavior? Please use eliminating the behavior of jumping on strangers as the example:

Have you worked with aggressive dogs? Have you worked with aggressive dogs? Yes No

If yes, explain what techniques in general you prefer to utilize to modify their behavior:

Preferred Training Methodology: Describe (please list below) your preferred training methodology (correction based, lure/reward, leash pops, checks, or a combination of all depending upon each dog, etc):

POSITIVE REINFORCEMENT: POSITIVE REINFORCEMENT: Lure/Reward Shaping Capturing Reward Marker (clicker) Other

If you marked "other" please explain.

CORRECTION BASED: CORRECTION BASED: Negative reinforcement Positive punishment Leash pops E collar Other

If you marked "other" please explain.

Type of Equipment Used for Training: (Please check all that apply) Type of Equipment Used for Training: (Please check all that apply) Slip Collar (chain or fabric) Pinch or prong collar Easy Walk Harness, Sporn or Sensation harness Other Harness Martingale, Greyhound or limited slip collar Head halter (Promise, Halti, or Gentle Lead) Flat collar Vibration or shock collar Noise deterrent (horn or training discs) Click or reward marker Food/treats/toys 6’ Lead Retractable lead Other

If you marked "other" please explain.

Have you taught, been a mentor or helped teach a potential dog trainer? Have you taught, been a mentor or helped teach a potential dog trainer? Yes No

Have you taught, been a mentor or helped teach a potential dog trainer? If yes, please explain:

Which TV shows, if any, do you watch for advice on methods of dog training or behavior? Have you worked with veterans or individuals suffering from PTSD or depression/anxiety?

Please provide contact details for 3 clients (Name, Email, Phone) you have worked with in the past performing obedience training or behavior modification. Reference #1

Please provide contact details for 3 clients (Name, Email, Phone) you have worked with in the past performing obedience training or behavior modification. Reference #2

Please provide contact details for 3 clients (Name, Email, Phone) you have worked with in the past performing obedience training or behavior modification. Reference #3