Skip to main content
Skip to footer
Mira homepage
Contact us
Shop
FR
Donate
Menu
About us
Mira
New identity
Our team
Our dogs
Adopt an unselected dog
Community engagement
Our partners
Scientific research
Medias
Changing lives,
one dog at a time.
Donate
Programs
Guide-dog
Mobility service dog
Service dog for youth with ASD
Institution Service Dog
Changing lives,
one dog at a time.
Donate
Get involved
General public
Donate
Become a Foster Family
Organize a fundraising event
Adopt an unselected dog
Have a stone engraved
Become a volunteer
Corporate
Corporate commitment
Cartridge recovery
Sponsor a signature event
Mira Presentation
Changing lives,
one dog at a time.
Donate
Events
News
Contact us
Shop
Donate
Institution Service Dog
Application Form
Institution information
Name of the institution for which you are completing an application*
Institution contact details (full address)*
Type of institution *
School
Police
CISSS/CIUSSS: Physical Rehabilitation Centre
CISSS/CIUSSS : DYP
CISSS/CIUSSS: Mental Health
CISSS/CIUSSS: Other
Community
Palliative care
Other
If you answered "Other", please specify :
Name and position of the director, resource person, or manager*
Telephone number of the director, contact person, or manager*
Email of the director, resource person, or manager*
Information about the person designated to be responsible for the assistance dog
Has a person responsible for the dog already been identified?*
Yes
No
Name of the person responsible
Job title of the person in charge
Phone number
Email
How do you plan to select the person in charge?
Project description
In a few sentences, describe your project (motivations, target audience, objectives, expectations, etc.)*
Eligibility criteria and requirements
I confirm that at the time of submitting the expression of interest, I can:*
Certify the absence of another dog at the home of the person responsible (at the time of allocation and afterwards);
Certify that the institution is aware of the existence of the five (5)-year agreement with Mira and of the $35,000 dog placement fee over a 5-year period;
Certify that the person responsible for the dog agrees to house the dog at their residence;
Confirm that the person in charge must be the handler or professional who works with the dog in contact with clients;
Guarantee that the person responsible is available to participate in a nine (9) day training class at Mira (meals and accommodation included).
* Required fields
Send