US K9 UNLIMITED, INC.

DOG TRAINING ACADEMY

VA BENEFITS
VERIFICATION FORM

YOUR VA FILE NUMBER:________________________________________________________

(you can get this from your Certificate of Eligibility you received from VA)

Full Name:______________________________________________________________________

Preferred Name:__________________________________________________________________

Former Name (if any):

_______________________________________________________________________________

Address:________________________________________________________________________

City:_________________________ State:_______ Zip:____________ Country:____________

Telephone (please list all applicable numbers):

_______________________________________________________________________________

EmailAddress:___________________________________________________________________

Birth date: ____________________________ Male: ____________ Female: _____________

SSN: __________________________________________________________________________

Have you ever been convicted of a felony? Yes_____ No_____

(if yes, please provide information)

Have you ever been arrested or convicted for possession or use of narcotics? Yes___ No_____
(if yes, please provide information)

US K9 UNLIMITED DOG TRAINING ACADEMY 10919 ODILON RD. KAPLAN, LA. 70548 1

USA
OFFICE: (855) 875-9364 info@usk9.com WWW.USK9.COM
FAX: 866.841.4910
 Please specify which Course Program and Program Date you are enrolling for.
See Training Calendar below for 2017 Course Dates offered
Programs offered based on availability - Some dates may be full-Your school official will consult with you

____ Single Purpose Handlers Program - $2,900.00 (4 Week Course). Certification for police dog
detection in narcotics or explosives.
Course Date:__________________________

____ Dual Purpose Handlers Program - $3,900.00 (5 Week Course). Certification for
police dog detection in narcotics or explosives with patrol functions.
Course Date:_________________________

____ Professional Trainers Program - $8,900.00 (12 Week Course). Certification

as a Professional Trainer in obedience/behavior, personal protection, police dog detection
in narcotics/explosives/patrol functions.
Course Date:______________________________

Canine Background
Please describe below any personal/professional experience you have working with dogs

Future Plans/Expectations
Please describe below what you plan to do with your training/certification

US K9 UNLIMITED DOG TRAINING ACADEMY 10919 ODILON RD. KAPLAN, LA. 70548 2

USA
OFFICE: (855) 875-9364 info@usk9.com WWW.USK9.COM
FAX: 866.841.4910
 REQUIRED
List any and all Schools/Classes for Higher Education you have previously attended Post High School
(include trade schools, University, Colleges, etc.). If you have not enrolled or attended fill-in N/A

________________________________ _________________________________
Print Name Signature

________________________________
Date

US K9 UNLIMITED DOG TRAINING ACADEMY 10919 ODILON RD. KAPLAN, LA. 70548 3

USA
OFFICE: (855) 875-9364 info@usk9.com WWW.USK9.COM
FAX: 866.841.4910
US K9 UNLIMITED DOG TRAINING ACADEMY 10919 ODILON RD. KAPLAN, LA. 70548 4

USA
OFFICE: (855) 875-9364 info@usk9.com WWW.USK9.COM
FAX: 866.841.4910