Reasonable Accommodations Verification – Assistance Animal

Property Name Date:

Telephone: () - Fax: () -

Email address:

Resident Name: Address:

This apartment community is committed to the letter and spirit of the Fair Housing Act, and Section 504 of the Rehabilitation Act, which among other things, prohibits discrimination against persons with disabilities. In accordance with ourstatutoryresponsibilities and management policies, we will make reasonable accommodations to policies, practices, services, and to our property when such accommodations are necessary to afford persons with disabilities an equal opportunity to use and enjoy their housing communities. Since some accommodations require a significate expense by our property, we attempt to do our best to understand whether the request for the accommodation is necessary and directly connected to the resident’s disability, or where the requested accommodation is merely a preference of the resident. You can assist us to make an informed decision by answering the questions below.

Dear Applicant/Resident, We will contact the qualified third party professional/health care provider and request he/she complete this form and return it to the above community. By your signature below, you are consenting for the verifier to release the below information and any follow up information necessary to make the determination on your accommodation request.

Applicant/Resident Signature


To whom it may concern:
Thank you for your assistance. Your name has been provided by this applicant/resident as a third party professional who can verify the applicant/resident’s need for the accommodation. After review of this information, it may be necessary for us to contact you again to clarify this information.
Please note: Under the Fair Housing Act, a disability is a physical or mental impairment, which substantially limits one or more of a person’s major life activities, has a record of having such impairment, or is regarded as having such impairment.The disability must be permanent (or continual or long duration) to be protected by the Fair Housing Act.
Yes / No / Unknown / Assistance Animal Verification
Does this applicant/resident have a disability, as defined by the Fair Housing Act?
Note that applying the definition of a reasonable accommodation to a request for an animal requires a higher standard than merely stating that a resident would “benefit” from the presence of an animal in his/her apartment, since presumably most pet owners benefit from the presence of their pets.
HUD’s definition of an assistance animal is as follows: An assistance animal is not a pet. It is an animal that works, provides assistance or performs tasks for the benefit of a person with a disability, or provides emotional support that alleviates one or more identified symptoms or effects of a person’s disability. Assistance animals perform many disability-related functions, including but not limited to, guiding individuals who are blind or have low vision, alerting individuals who are deaf or hard of hearing to sounds providing protection or rescue assistance, pulling wheelchair, fetching items, alerting persons to impending seizures, or providing emotional support to persons with disabilities who have a disability-related need for such support.With that understanding please answer the following questions:
Yes / No / Unknown / Assistance Animal Verification
Is it your opinion that the presence of an animal in this applicant/resident’s apartment is necessary because of his/her disability for this applicant/resident to use and enjoy this apartment community.
Please describe the nexus or connection between the applicant/resident’s disability and the requested accommodation of an assistance animal.
If you answered yes to the question at the top of this page, is there a specific animal, number of animal(s) or type of animal(s) that is (are) necessary? If yes, please explain.

This property

Answer this question if property allows pets. If in your professional opinion this resident’s disability makes an assist animal necessary, please describe how an assistance animal would perform tasks or alleviate the symptoms or effects of this resident’s disability in a different manner than a pet.



Yes / No / Assistance Animal Verification
Are you aware that if this matter is litigated it may be necessary for you to testify to the accuracy of the information you have provided concerning this applicant/resident’s request?

Print name of person providing this information:

Title/Company/License #


Telephone Relationship to applicant/resident:

Signature: Date:

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3008 Assistance Animal Verification 061917