Emotional Support Animal Request Form

Emotional Support Animal Request Form

Saint Elizabeth University Office of Accessibility Services and Residence Life
Office of Accessibility Services
Saint Elizabeth University
Phone: (973) 290-4261
Email: accessibility@steu.edu

Please read this entire form.

Students may request an Emotional Support Animal if they have a qualified medical condition or psychological/medical/psychiatric /physical disability as defined by the Americans with Disabilities Act Amendments Act (2008). The initial request is to be made with the Accessibility Services Coordinator by filling out this jotform, and attaching requested documentation. After you submit your form, Accessibility Services will reach out to you with next steps. Please note that no animals may be brought on campus until all required documentation has been received and you have received an email of approval from Accessibility Services with a signed agreement, signed by Accessibility Services, Head of Security and the Director of Housing. Unfortunately, we are unable to process requests for animals that need heat lamps.

Before beginning this process, please note that you will need the following documentation to begin a request for an Emotional Support Animal.
- Completed Emotional Support Animal Physician Form,and any other supporting medical documentation supporting this request. (All Emotional Support Animals).
- Dog License
- Proof of up to date rabies shot.
- Veterinarian records on official letterhead that states that your animal is healthy and is not aggressive and is vaccinated appropriately according to their species.
Once you have filled out this jot form and uploaded all requested documentation, Accessibility Services will contact you via email about next steps.
Name*

First NameLast Name
SEU ID #*
SEU Email*
example@example.com
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Current Housing Building/Assignment*
Room Number*
Do you have a roommate?*

YesNoDon’t know yet
Cell Phone Number*
Please enter a valid phone number.
Please indicate the reason for your request for an Emotional Support Animal*
What is your diagnosis?*
How does the stated request for an Emotional Support Animal relate to your condition?*
What is your Emotional Support Animal’s name?*
What species is your Emotional Support Animal? (eg. Dog/Cat)*
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Assistance with Forms
Students who need assistance with filling out forms, uploading forms or who need to deliver their documentation in person may email accessibility services at Accessibility@steu.edu or call 973-290-4261 for assistance.
Please upload the following files:
- the completed Emotional Support Animal Physician Form signed by a licensed psychologist/psychiatrist.
- any other supporting documentation from your psychiatrist/psychologist.
- documentation from your veterinarian that your Emotional Support Animal is healthy, not aggressive, and is vaccinated by law according to its species.
If your emotional support animal is a dog
- your support dog's license (please note, your request for a dog cannot be processed without a dog license)
- your dog’s rabies vaccination (must be a USDA licensed rabies vaccine, and current and up to date. Please note that if this is your dog’s first dose of the rabies vaccine, they are not considered “currently vaccinated” until 28 days after their initial dose. Please take this wait time into consideration. Your request cannot be approved until your dog is “currently vaccinated”)
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Emotional Support Animal Request Form

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