EMU Service Animal Registration

EMU is committed to allowing individuals with disabilities the use of a service animal, as defined by the ADA, on campus to facilitate their full participation and equal access to EMU’s programs and activities.

For EMU’s general rules around service animals, please see the EMU’s Service Animal Policy and Procedure.

Students must register the service animal with the Office of Academic Access (OAA) no later than 30 days before the proposed use on this form.

To register, please complete and submit the Service Animal Registration form, documentation of the animal's city, county and state required vaccinations and proof of license, along with documentation from a regulated health professional, confirming that the student requires the animal for reasons relating to the disability. The documentation should include:

• Name of health professional;
• Name of their regulated health profession body. and registration number with that body;
• Name of the individual being accompanied by the animal;
• Written confirmation that the named individual requires a service animal for reasons
relating to a disability; and
• Species of the service animal required (eg. dog).

If a student has more than one service animal trained to perform a different task, the student must complete a registration form for each service animal.

To complete your request, this form must be completed confirming you have read the Service Animals Policy and Procedure. Once submitted to the OAA, you will be notified of a decision, and appropriate follow up will proceed with the OAA director if approved. For questions about this process, please email oaa@emu.edu.

Please answer the following two questions as stated in the ADA.

Note that under the ADA, the registration request may be denied or revoked if the student/owner/handler is unable to answer both questions.
Is the service animal required because of a disability?

Is the service animal required because of a disability? Yes No
What specific work or task has the animal been trained to perform?
Emergency Contact
Please name an emergency contact person (someone other than a student) to accept and care for the service animal in the event it needs to be removed from EMU housing.
Written Consent
Please provide written consent for the OAA to disclose information regarding the request for and presence of the service animal to those individuals who may be impacted by the presence of the service animal including, but not limited to, residence life personnel and potential and/or actual roommate(s)/neighbor(s).
Will you be a resident in EMU housing?

Will you be a resident in EMU housing? Yes No
Service Animal Being Registered
Animal Name
Species
Service Animal Owner/Handler Contact information
Owner/Handler Name Owner/Handler Name First Last
Email
ID Number
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Emergency Contact Name Emergency Contact Name First Last
Please name an emergency contact person (someone other than a student) to accept and care for the service animal in the event it needs to be removed from EMU housing.
Emergency Contact Email
Emergency Contact Phone
Animal Health Status
Animal has all veterinary-recommended vaccinations based upon provided documentation including the rabies immunization.

Animal has all veterinary-recommended vaccinations based upon provided documentation including the rabies immunization. Yes No Other Other
Agreement

By signing this form, I agree that the behavior and presence of the service animal:
• will meet reasonable standards regarding behavior, noise, odor and waste, and;
• will not create unreasonable disruptions for members of the EMU community.

I agree that, when on campus, as the owner/handler of the service animal, I am solely responsible for the supervision of the service animal. This will normally involve ensuring control through appropriate restraint methods as necessary, and the keeping of the animal in close proximity to me.

I also understand that service animal access on our campuses may be restricted for reasons that include health and safety requirements set out in law, health and safety concerns of or threats to others, location-specific safety requirements, or restrictions on certain types of animals under municipal laws. Information may be shared with university staff but only to bring the best resources to assist you in facilitating support, and only on a need-to-know basis to perform their duties and to provide disability-related accommodations on campus.

I confirm that I have read EMU’s Service Animal Policy and Procedure.
I confirm that, if an EMU resident, I have reviewed the housing expectations.
Draw your signature into the box below.

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Full Name

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Today's Date Today's Date / MM / DD YYYY

EMU Service Animal Registration

EMU Service Animal Registration

Please answer the following two questions as stated in the ADA.

Emergency Contact

Written Consent

Service Animal Being Registered

Service Animal Owner/Handler Contact information

Animal Health Status

Agreement