Service & Support Animal Form

Support Animal Request Form

  • This form should be completed by the student! In order to request a Support Animal, the additional documentation form is required for the application to be processed.

  • Section I: Demographic Information

  • Section II: Accommodation Request Information

  • If you currently have a medical housing accommodation and are renewing your application, you may need to have a physician complete the Housing Accommodation Documentation Form. If you are submitting a new application for a medical housing accommodation, please make sure your physician completes the Service & Support Animal Information Request form in order for your request to be reviewed.
  • Section III: Final Review & Submission

    Please review and initial the following statements:
  • This field is for validation purposes and should be left unchanged.

Please print this form and give it to your health care provider. They should return the completed form to Accessibility Services at Wagner College.

Request for Information- Licensed Medical Professional