Important: Please notify us if you decide not to complete this portion.
The following items must be completed and returned to Mira USA as part of the Mira USA Guide Dog application process. Please use this page as your checklist. Email all forms to info@mirausa.org or mail them to Mira USA, 510 NW Broad St., Southern Pines, NC 28387.
Required Forms:
☐ Formal Guide Dog Application
☐ Candidate’s Information Release Form
☐ Candidate’s Publicity Release
☐ Parent/Guardian Publicity Release
☐ Physician Medical Report
☐ IEP (Individualized Education Plan) and/or VI Teacher Report
Optional Training Video:
□ O&M Approach to Training for Guide Dog Travel
Please read through everything carefully so you understand each part of the process and what is required. This page outlines everything that must be completed for your child’s evaluation.
We will also send a separate set of materials to your child’s Orientation & Mobility (O&M) Instructor to be completed. We will notify you once we receive all the required information from them.
Please use this checklist to stay organized. You may submit each item to Mira USA as soon as it is completed—there is no need to wait until everything is finished before sending documents. Completing these steps promptly is helpful, as the evaluation process is very lengthy and requires time and coordination from all parties involved, including your family, your child’s O&M Instructor, their school and medical professionals, and Mira USA.
Each guide dog partnership represents an investment of approximately $70,000, which includes breeding, raising, training, evaluation, travel, lodging, and the child’s month-long stay in Canada for guide dog school. All these costs are fully covered by Mira USA at no cost to you or your family.
Because every guide dog team represents a significant commitment, our application process is detailed and thorough. Your careful attention to each step helps us support your child and prepare them for a safe and successful guide dog partnership.
Before completing the forms and documents in this packet, all families must first submit the Formal Guide Dog Application. This application provides Mira USA with essential background information about your child and your family, and it must be completed before any additional materials can be reviewed.
Our Commitment to Inclusion and Diversity
Mira USA welcomes applicants from all backgrounds. We are committed to providing equal access to our program regardless of race, ethnicity, nationality, gender, gender identity, sexual orientation, religion, family structure, or socioeconomic status. Every child deserves the opportunity to gain independence, mobility, and confidence through the support of a guide dog.
Home Requirements for Guide Dog Placement
As part of the application process, please be aware that Mira USA does not allow guide dogs to be placed in homes where other dogs are present. This policy is applied universally—both in Canada and the United States—because the presence of other dogs in the home can create challenges and risks for the training, safety, and long-term success of the guide dog partnership.
If your family currently has other dogs in the home, they must be rehomed before your child can be paired with a guide dog.
Once you have submitted the formal application, you may continue with the checklist and the remaining steps in this packet.
Click Below to download the Formal Guide Dog Application
The Information Release Form allows us to request medical, educational, O&M, and other professional records related to your child’s evaluation. This includes permission to contact your child’s Orientation & Mobility (O&M) Instructor, who plays an important role in the assessment process.
The Publicity Releases give us permission to share photos and updates online and in print media about you and your child during the application process and after they receive their guide dog.
Please complete these forms as soon as possible and return them to Mira USA. Once we receive them, we can immediately begin communication with your child’s O&M Instructor, whose portion of the process can be lengthy. Please contact Mira USA if you have any questions.
Click below to download the forms
Candidate’s Information Release Form
Candidate’s Publicity Release
Parent/Guardian Publicity Release
These documents provide important background information about your child’s health, education, and support services. They help us understand your child’s needs and ensure their guide dog training will be safe and appropriate. Your physician is welcome to use their own report if it includes most of the information on our form.
Click below to download the Medical form
Physician Medical Report
IEP (Individualized Education Plan) and / or VI Teacher Report – submit the school’s form
Your child’s Orientation & Mobility Instructor is required to watch this training video and begin implementing the techniques shown. We also strongly encourage parents to watch it, as it explains what skills your child will be working on in preparation for a guide dog.
You may submit your forms in the way most convenient for you.
You may email completed forms directly to info@mirausa.org.
For larger files, you may upload them to a cloud service such as Google Drive, Dropbox, OneDrive, or iCloud and email the link to info@mirausa.org.
You may also mail completed forms to:
Mira Foundation USA - 510 NW Broad Street, Southern Pines, NC 28387.