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Allen S Henry Bulding

ESA Agreement and Acknowledgement Form

ESA Agreement and Acknowledgement Form

As a student requesting an Emotional Support Animal (ESA) through the Office of Accessibility Resources (OAR), I understand that I have responsibilities to both myself and my ESA here at Florida Tech. As part of receiving such accommodations, I agree to the following:

  1. I will contact OAR if I experience difficulties that may interfere with my living accommodation.
  2. I will comply with applicable local, state, and federal laws concerning the ownership of an animal.
  3. I will name someone (not a student in residence) as the emergency contact should someone else need to care for the ESA unexpectedly.
  4. If I seek to replace the ESA with another, I will file a new accommodation request with OAR.
  5. I understand that the ESA must be under my control at all times.
  6. I understand that an ESA is only allowed to be in the residence room except to the extent the individual is taking the animal out for natural relief.

By my signature below, I verify that I have read, understand, and will abide by the requirements outlined in this agreement. I agree to keep the additional information required up to date under Florida Tech’s procedures for an ESA under Housing and Residence Life.

I will abide by the requirements applicable to an ESA. I understand that if I fail to meet the requirements, Florida Tech has the right to remove the ESA, and I will be required to fulfill my obligations to Campus Services and Residence Life.

I give permission to OAR, in conjunction with Housing and Residence Life, to disclose to others impacted by the presence of my ESA (e.g. Residence Life staff, potential and/or actual roommate(s)/neighbor(s)), that I will be living with an animal as an accommodation. I understand that information will be shared with the intent of preparing for the presence of the ESA and/or resolving potential issues associated with the presence of the ESA.

I recognize that the presence of the ESA may be noticed by others visiting or residing in college housing and agree that staff may acknowledge the presence of the animal and explain that under certain circumstances an ESA is permitted for persons with disabilities.

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