Service or
assistance animal form

Application of Approval for Service or Assistance Animal

Name(Required)
Request For(Required)
Please Note: Assistance Animals are for campus housing only.
Type of Animal(Required)

Additional Documents

1. Proof of animal vaccination

2. Documentation from a health care provider or another qualified person which verifies the existence of a disability (without specifics on the nature of the disability) and disability-related need for the assistance animal.

Note: This application will not be approved until all additional documents are submitted.
Acknowledgment

Student/applicant signature signifies that the student acknowledges and agrees to abide by IVCCD Board Policy 526 Service and Assistance Animal Policy, and the guidelines set as to, but not limited to, the location, care, and control of the approved animal.
Signature
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