Emotional Support Animal Agreement for On-Campus Housing
The owner of an emotional support animal must:
❏ Be registered with the Office of Student Accessibility and have a letter of accommodation
specifying an Emotional Support Animal
❏ Comply with any and all county, state, or federal licensing requirements, as appropriate for
the animal, with copy of licenses submitted to OSA
❏ Follow their veterinarian’s care recommendations and vaccinations for the animal, with copy
of health record submitted to OSA
OSA Director Name Signature Date
Support Animal Information:
Name Type (dog, cat, etc.) Breed/Color
Age/Weight LA County License # Gender? Neutered?
❏ Have written, voluntary consent from all room/suite/apartment-mates confirming
agreement to the presence of the animal in the student’s room and a complete Roommate
Expectation Agreement
❏ Be financially responsible for any bodily injury or property damage caused by the animal, in
addition to the cost of extra cleaning due to the animal
❏ Control the animal by keeping the animal leashed when outside or supervised by the owner
within the shared dwelling space at all other times
❏ Cleanup and appropriately dispose of the animal’s waste
❏ Keep the animal in the student housing community at all times, understanding that the
animal is not allowed in the classrooms, cafeteria, or other campus areas
Failure
to
adhere
to
this
agreement
is
considered
a
violation
of
our
residential
student
policy
and
could
result
in
a
judicial
hearing.
Student Name Signature Date
HRL Staff Name Signature Date
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signature
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signature
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signature
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