Reasonable Accommodation Request Form

This form is used for tenants to request reasonable accommodations and reasonable modifications to rental homes due to their disability. GTL Real Estate is a proud supporter of Fair Housing laws.

Name*

First NameLast Name

Rental Property Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Area CodePhone Number

Email*

example@example.com

I hereby assert that I have a physical or mental impairment that limits my ability to occupy or fully enjoy the rental housing unless reasonable accommodations or modifications are made:*

Yes

I request the following type of reasonable accommodation:*

A change in the broker/landlord's normal policies, practices, or proceduresA physical change to the housing itselfOther

Please describe the change in policy, procedure, or practice that you request:*

Please describe the physical modification to the rental housing that you request:*

Please note that if your impairment is not obvious to a reasonable observer, it may be necessary for a member of our staff to ask you for information about your impairment so that we can ascertain the reasonableness of the request. This information will be kept confidential and only used for the purpose of considering your request. Please also note that you should not include such information on this form if you value the privacy of such information. This form is not encrypted, and the security of such information submitted using this form cannot be guaranteed. Therefore, you should only submit your requested accommodation(s), and not the specific nature of any personal information that may not be obvious to other individuals. If that information is needed, a member of our staff will contact you after reviewing this form.