Form TSA Form 433 TSA Form 433 Adoption Application

OMB control number 1652-0067
Exp. 08/31/2020

DEPARTMENT OF HOMELAND SECURITY

Transportation Security Administration
ADOPTION APPLICATION
Instructions: Carefully read this form and complete the application accordingly. Completed applications can be
returned by U.S. Mail Department of Homeland Security – TSA Canine Training Center (CTC) – ATTN: Adoption
Program – 2700 Craw Avenue, Building 7337, JBSA-Lackland, TX 78236-5217; Fax: (210) 671-4911, or send the
application as an attachment to [email protected]
Requirements: Applicants must have a secure fenced yard. The age of children in the home and the breed of the
dog being adopted will be taken into consideration. There should be no intentions of moving within six months of
adopting a dog. Homes must abide by all local pet ordinances. All pets in the home must have current vaccinations
and preventative care. Applicants will be required to travel to the TSA CTC to meet and pick-up the dog. There is a
continual need for good homes; however, there may not be dogs immediately available for adoption. Wait time will
increase if there is breed, gender, age, or color specifications. Qualified applications are kept in the order they were
received. Once, contacted, dogs are adopted on a first come first serve basis. The dogs are highly active in most
cases, untrained and not house broken. Once a dog is selected, the adoption typically takes (3) to (5) business days,
but may take longer.
Section I. Household Information (print legibly)
List names of the primary applicant (last, first, MI) and the names of the adults in the home. Only list the ages of children in
the household who are under 18 (no name required).

Address (street, city, state, zip)

Phone

Primary Email

List the adults employed outside the home, type of employment and regular hours

Do you own or rent your own home? (Attach written permission/lease agreement if applicable)

Rent

Own

Are you moving within the next 6 months? Do you have a secure fenced yard? (Underground or electric fences do not
qualify for the program and are not considered secure.)
Yes
No
Yes
No
What is the size of your backyard? (List the type and height of the fencing.)
Where will the dog be kept when someone is home?

Where will the dog be kept when no one is home?

Where will the dog be kept at night? Where will the dog be kept if you go on
vacation?

TSA Form 433 (3/19) rev. [File: 3500.12.1]

What is the maximum number of hours
the dog will be left alone?

Page 1 of 3

What is your dog ownership experience?

Do you have dog training experience?

Do you have experience with crate training a dog?

Do you have experience with large breed dogs?

Is anyone in the home allergic to dogs?
Yes

No

Why do you want to adopt a dog from TSA CTC?

What characteristics are you NOT willing to work with?

What would you do to correct unwanted behaviors?

What type of dog are you interested in adopting (Being breed, gender, color, or age specific will lengthen your wait
time)

Section II. Personal References (Please do not list family members or individuals residing in the same residence.)
Name
Email
Phone

Name

Email

Phone

Section III. Pet Information (Additional pets can be listed in an email or handwritten on additional sheet of paper.)
Breed or Type of Pet
Gender
Age

Spayed or Neutered

Last Vaccinations

Heartworm Preventative Type

Where are they housed?

Breed or Type of Pet

Gender

Age

Spayed or Neutered

Last Vaccinations

Flea Preventative Type

Heartworm Preventative Type

Where are they housed?

Breed or Type of Pet

Gender

TSA Form 433 (3/19) rev. [File: 3500.12.1]

Flea Preventative Type

Age

Page 2 of 3

Spayed or Neutered

Last Vaccinations

Flea Preventative Type

Heartworm Preventative Type

Where are they housed?

Breed or Type of Pet

Gender

Age

Spayed or Neutered

Last Vaccinations

Flea Preventative Type

Heartworm Preventative Type

Where are they housed?

Breed or Type of Pet

Gender

Age

Spayed or Neutered

Last Vaccinations

Flea Preventative Type

Heartworm Preventative Type

Where are they housed?

Section IV. Veterinarian Information (A veterinarian must be provided. If you do not have a veterinarian, list the one
you will use after you adopt a dog.)
Name of Clinic

Address

Phone

Email

Do we have your permission to request
information from your veterinarian?
Yes

No

How did you hear about the program?

I am aware the dog is located at the TSA CTC in San Antonio, Texas. If selected, it will be my responsibility to
transport the dog from the CTC facility to my home.
I agree to provide heartworm and flea preventatives, vaccinations, and any necessary medical care for the
duration of the dog’s life.
By signing this document, I attest to the fact that the above information is true and I understand that providing false
information may result in the nullification of this adoption.
Date:
Privacy Act Statement: AUTHORITY: 49 USC § 555; 41 CFR § 102-36-30; 41 CFR § 102-36.35(d); and 41 CFR §102-36-365. PRINCIPAL
PURPOSE(S): This information will be used to manage the canine adoption process at the TSA Canine Training Center. ROUTINE USES(S):
This information may be shared with the Department of Defense (DOD) Military Working Dog program in accordance with 10 USC § 372(a), and
under the Privacy Act including routine uses identified in the TSA system of records, DHS/TSA-006 Correspondence and Matters Tracking
Records. DISCLOSURE: Furnishing this information is voluntary; however, failure to provide the requested information may prevent TSA from
approving this application. Paperwork Reduction Act Statement: TSA will use the information to determine the suitability of respondents to adopt
TSA canine. This is a voluntary collection. It is estimated that the total annual burden per response associated to this collection is approximately
10 minutes. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information, unless it displays a
valid OMB control number. The control number assigned to this collection is OMB-1652-0067, which expires 08/31/2020. Send comments
regarding this burden estimate or any other aspect of this collection of information including suggestions for reducing this burden to TSA PRA
Officer, 601 S. 12th Street, Arlington, VA 20598-6011. ATTN: PRA 1652-0067.

Previous editions of this form are obsolete.

TSA Form 433 (3/19) rev. [File: 3500.12.1]