Organization Name:
Registration Number (e.g. Chamber of Commerce or Charity Identification Number):
Year of Founding:
Executive Director (or equivalent):
Named Person:
Mailing Address:
Place/City:
Postcode/Zip Code:
Country:
Phone number:
Email address:
Website:
Social Media – Facebook etc:
Describe the reasons why you wish to become a member of AAII:
Please describe how many people in each category you have served in the past year:
AAA (Animal Assisted Activities)
AAE (Animal Assisted Education)
C-AAE (Collaboration in AAE- no named licensed/degreed teacher in organization)
AAT (Animal Assisted Therapy)
C-AAT (Collaboration in AAT- no named licensed/degreed healthcare provider in organization)
AASP (Animal Assisted Special Programs)
AAPP (Animal Assisted Placement Programs)
Which fields are you requesting membership for? These should correspond to the areas you are active in above. If you are not yet active in any of these areas, please select up to 3 categories you are most interested in pursuing. For further information, please refer to the Glossary of Terms, Fields and Criteria and FAQ sections on the AAII website or the definitions at the end of this document. If you choose AAE or AAT, please send copy of your healthcare or educational degree certificate/license with your application. AAA (open to organizations only) AAE (open to organizations/individuals with active primary or special education degree) C-AAE (open to organizations/individuals that collaborate with licensed/degreed educators for AAE) AAT (open to organizations/individuals with healthcare or human service license/degree) Examples of relevant qualifications are psychologist, mental health provider, occupational therapist, physical therapist, speech therapist, social worker, etc. C-AAT (open to organizations/individuals that collaborate with licensed/degreed healthcare/human service providers for AAT programs) AASP (open to organizations and individuals who provide professional programs other than AAT and AAE). AAPP (open to professional organizations and individuals who professionally train dogs or assist self-training teams for work in AAA, AAT, AAE, or AASP)
What type of programs does your organization offer (please tick ALL that apply according to AAII definitions listed below) and describe each program.
Please list the professional qualifications, licenses and experience (human and animal related) of the key people in your organization – these may be staff, directors, trustees etc. Please attach copies of licences/degrees for AAE and AAT below after you have submitted the application form.
We do not use training or handling methods that include positive punishment, negative reinforcement, eliciting fear, pain, hitting, yelling, intimidation, threats, force, coercion, shock collars, prong collars, leash pops, physical force, pain inducing, Alpha rolls, holding dogs down or any other aversive techniques: Yes No
Signature:
Date:
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