Verification Addendum

Please also submit a CLASS Office Verification Form

Student’s Name:                                                                                     

Re: Proposed ESA
Type of animal: ___________________  (if known); Age of animal: ___________________  (if known)

The above-named student has indicated that having an Emotional Support Animal (ESA) in the residence hall at Augsburg will be helpful in alleviating one or more of the identified symptoms or effects of the student’s disability. Providers completing this form should be treating the student and should be from the same state as the student (either Minnesota or the student’s home state). The information in the questionnaire will be used to determine the appropriateness of the request for an ESA. 

Information About the Proposed ESA
Is this a new animal that you specifically recommend as part the student’s treatment plan, or is it a current pet you believe will have a beneficial effect for the student while in residence on campus? 

If it is a new animal, what symptoms will be reduced by having the ESA? Please explain.

If the student already has the animal, how has it helped alleviate their symptoms? Please explain.

Have you discussed the responsibilities associated with properly caring for an animal while engaged in typical college activities and residing in campus housing? Do you believe those responsibilities might exacerbate the student’s symptoms in any way? 

Is the animal necessary for the student to fully participate in residential life on campus?