Disability Support Services
Service and Support Animal Housing Accommodation Form Please review the University’s Service and Support Animal Policy prior to submitting this form to the DSS Team in the Learning Center. Refer to the policy for the complete process for requesting disability-related housing accommodations, including deadlines and required disability documentation. Visit www.liu.edu/ about/university-policies/service-and-support-animal-policy for more information. Students must reapply each year for accommodations (previous accommodations are not automatically extended). This form should be submitted to the Learning Center. All resident students are also required to submit a housing application via their MyLIU account by the required deadlines. For general questions regarding University Housing, contact LIU Promise at bkln-promise@liu.edu or post-promise@liu.edu.
LIU ID Number:
Name: Phone Number:
LIU Email Address:
Semester(s) for Accommodation:
Fall
Spring
Summer Year:
Student Type: (select one) First-Year Student
Undergraduate Student
Transfer Student
Graduate Student
Request Type: (select one) Request to have Service Animal in University Housing (please see policy for additional required information) Request to have Support Animal in University Housing (please see policy for additional required information) Current Univeristy Housing Assignment: (include building and room) Housing Preferences:
Please sign and date below, indicating that you have read the University’s Service and Support Animal Policy. Submit your request and appropriate documentation to the Learning Center. Student Signature:
Date:
Learning Center www.liu.edu/learningcenter LIU Brooklyn, Global, and Hudson Campuses LIU Brooklyn, Library Learning Center, 4th Floor Phone: 718-488-1095 Email: Bk-learningcenter@liu.edu
LIU Post and Riverhead Campuses
LIU Post, B. Davis Schwartz Library, 1st Floor Phone: 516-299-3057 Email: Post-learningcenter@liu.edu
Roommate/Suitemate Acknowledgement
This section is only applicable to Long Island Univeristy students living in University Housing with roommates and/or suitemates. By signing below, I understand that I will share the common areas of my assigned residential space with the animal approved by this agreement. Should I have any concerns regarding the care and control of the approved animal, I will discuss my concern’s with the approved animal’s owner and then the Learning Center if the approved animal owner and I cannot come to an agreement. Roommate/Suitement 1: Name: Signature:
LIU ID Number: Date:
Roommate/Suitement 2: Name: Signature:
LIU ID Number: Date:
Roommate/Suitement 3: Name: Signature:
LIU ID Number: Date:
Roommate/Suitement 4: Name: Signature:
LIU ID Number: Date:
Roommate/Suitement 5: Name: Signature:
LIU ID Number: Date:
Roommate/Suitement 6: Name: Signature:
LIU ID Number: Date:
Roommate/Suitement 7: Name: Signature:
LIU ID Number: Date: