Submit A Reasonable Accommodation Request (Including Requests for An Assistance Animal/ESA)

We have created this form as a convenient way for you to make a request for a reasonable accommodation if you have a disability. You can use this form to make any reasonable accommodation request, including for an assistance animal (sometimes referred to as an "emotional support animal" or "ESA"). If you require assistance completing this form, or you wish to make the request orally, please contact our office by phone or email. Please contact our office if you have any questions or concerns.

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Basic Information

First let's gather your information.

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Your Name(Required)

First Last

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Your Email(Required)

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Your Phone(Required)

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What is (or will be) the tenant's RentAmes rental address?(Required)

Street Address Address Line 2 (Unit Number) City

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Is the person completeing this form the tenant?(Required)

If the person requesting accommodation is different from the tenant, choose no.

Yes

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What is the tenant's name?(Required)

First Last

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Indicate your relationship to the tenant:(Required)

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Type of Request

Next let's get information on the type of reasonable accommodation you are requesting.

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Are you making a request for permission to have a service animal or an assistance animal in your house or apartment?(Required)

This includes what is sometimes referred to as an "Emotional Support Animal" or "ESA".

Yes

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Accommodation Request

Next let's get more details on the specifics of your request.

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Please describe the reasonable accommodation you are requesting.(Required)

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Please explain why this reasonable accommodation is needed. You need not provide detailed information about the nature or severity of the disability.(Required)

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If you would like to upload documentation in support of your request you may do so here.

Drop files here or

Accepted file types: jpg, jpeg, gif, png, pdf, Max. file size: 10 MB, Max. files: 10.

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Request for Permission for Service Animal or Assistance Animal

Next let's get more details on the specifics of your request.

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Is it readily apparent that the animal is a trained service animal (such as an animal trained to assist you with a visual impairment or similar disability)?(Required)

Persons requesting permission for an "emotional support animal" or "ESA" most likely will answer NO to this question. Please be warned, it is illegal under Iowa law to intentionally misrepresent that an animal is a service animal.

Yes

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Are you willing to provide basic information about the service animal?(Required)

We would like to get information about the animal solely for recordkeeping purposes and to assist us in our management duties. The information would include (a) what type of animal, (b) the name of the animal, (c) the animal's breed, and (d) the approximate weight of the animal.

Yes

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Request for Permission for Service Animal or Assistance Animal Continued

Let's get some information about your service animal or assistance animal.

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What is the type of animal?(Required)

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What is the name of the animal?

This question is for recordkeeping purposes only.

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What is the breed of the animal?

This question is for recordkeeping purposes only.

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What is the approximate weight of the animal?

This question is for recordkeeping purposes only.

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Is the animal required because of a disability?(Required)

Persons requesting permission for an "emotional support animal" or "ESA" most likely will answer YES to this question.

Yes

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Does the animal perform work or do tasks for you because of your disability?(Required)

Yes

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Our Request for Information & Documentation

To process your request, we request certain information and documentation be provided for your request for an animal that performs work or tasks for you.

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1. Please provide an explanation of how the animal has been trained to do work or perform tasks that ameliorate one or more symptoms or effects of your disability or, if the animal lacks individual training, how the animal is able to do work or perform tasks that ameliorate one or more symptoms or effects of your disability.(Required)

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Note: For the next question you may, but are not required, to use the form at this link for your statement from a health or social service professional.

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2. You are requested to provide a statement from a health or social service professional indicating that you have a disability (i.e., you have a physical or mental impairment that substantially limits one or more major life activities).

You may upload the statement here. Or you can submit your form and provide the statement to us in-person, by mail, or by email.

Drop files here or

Accepted file types: jpg, jpeg, gif, png, pdf, Max. file size: 10 MB, Max. files: 3.

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3. You are requested to provide proof of current vaccinations for the assistance animal.

You may upload the current vaccination records here. Or you can submit your form and provide the records to us in-person, by mail, or by email.

Drop files here or

Accepted file types: jpg, jpeg, gif, png, pdf, Max. file size: 10 MB, Max. files: 5.

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Our Request for Documentation

To process your request, we request certain information and documentation be provided for your request for an animal that does not perform work or tasks for you, but provides support or ameliorates one or more effects of your disability.

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Note: For the next question you may, but are not required, to use the form at this link for your statement from a health or social service professional.

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1. You are requested to provide a statement from a health or social service professional indicating: (a) that you have a disability; (b) the animal would provide emotional support or other assistance that would ameliorate one or more symptoms or effects of your disability; and (3) how the animal ameliorates the symptoms or effect(s).

You may upload the statement here. Or you can submit your form and provide the statement to us in-person, by mail, or by email.

Drop files here or

Accepted file types: jpg, jpeg, gif, png, pdf, Max. file size: 10 MB, Max. files: 3.

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2. You are requested to provide proof of current vaccinations for the assistance animal.

You may upload the current vaccination records here. Or you can submit your form and provide the records to us in-person, by mail, or by email.

Drop files here or

Accepted file types: jpg, jpeg, gif, png, pdf, Max. file size: 10 MB, Max. files: 5.

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Acknowledgement & Submission

A few final questions to wrap up.

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Please provide any additional requests, details, or comments not addressed elsewhere in this form.

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Acknowledgement(Required)

After your request is submitted it will be reviewed and a response issued to you within two weeks. If you do not hear from us in that time, please contact our office by phone or email. If we have requested documentation from you that has not been provided with this form, we will wait for that documentation to be submitted before a response will be issued. If you have requested permission for a service animal you acknowledge that you have been warned that it is illegal under Iowa law to intentionally misrepresent an animal as a service animal.

I acknowledge I have read the above terms

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Please sign this form by typing your name.(Required)

By typing your name below you certify that you are the person named and that you consent to the use of an electronic signature.

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