Pepperdine University
Emotional Support Animal Agreement for On-Campus Student Housing
Academic Year 2017-2018
The owner of an emotional support animal must:
❏ Be registered with the Office of Student Accessibility
❏ 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 Initials Date
❏ Have written, voluntary consent from all room/suite/apartment-mates confirming
agreement to the presence of the animal in the student’s room, with a copy of the
consent submitted to HRL
❏ 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
Support Animal Information:
_____________________ _____________________ ___________________________
Name Type (dog, cat, etc.) Breed/Color
_____________________ _____________________ Neutered? Y N
Age/Weight LA County License # Gender? M F
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