Accessibility Resources- ESA Student Request Form

Assistance Animal Student Request Form

Assistance Animal Health Professional Acknowledgement

An Assistance Animal accommodation request cannot be reviewed without the Assistance Animal Health Professional Form. It is the student’s responsibility to provide this form to the appropriate professional for completion and to include it with the request.

Assistance Animal Health Professional Acknowledgement

I acknowledge I have a completed Assistance Animal Professional Form to include with my request

Student's Full Name:

UC Email:

Please enter your UC email address. Approval decisions will ONLY be communicated via UC email accounts.

M#:

Campus Housing Address

Type of animal

Age of animal

For what disability are you requesting an Assistance Animal?

How does your disability impact your ability to have equal access to UC's residential community?

Explain why an Assistance Animal is necessary to manage your symptoms and gain equal access to UC Housing communities.

What strategies do you currently use to manage your symptoms?

If approved, when do you want the accommodation to begin? Students seeking an accommodation beginning FALL 2022 should NOT complete this form until May 2nd or later, when Fall 2022 is an option on the form.

Spring 2022

Summer 2022

Other...

Please share any additional information you would like to provide.

Assistance Animal Health Professional Form Upload

Please upload your completed Housing Accommodation Assistance Animal Health Professional Form.

Additional uploads:

Upload any additional documentation, assessments, etc. in support of your housing accommodation request.

Assistance Animal Student Request Form

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