Reasonable Accommodation Request Resident/Applicant InformationComplex Name(Required)Unit Number(Required)Full Name(Required) First Last Phone Number(Required)Email Address(Required) Date of Request(Required) MM slash DD slash YYYY Nature of RequestIs this request regarding an assistance animal?(Required) Yes No If yes, how many animals are you requesting to keep in your unit?(Required)Please enter a number from 1 to 10.Please describe the specific modification, exception, or change you are requesting to our standard property policies(Required)Disability-Related NeedPlease explain the relationship between your disability and the request being made(Required)Note: You are not required to disclose your specific diagnosis or medical records.CertificationCertification(Required) I certify that the information provided is true and accurate. I understand that Holton Mountain Rentals evaluates each request on an individual basis to determine if the requested accommodation is reasonable and supported by a disability-related need. Signature(Required)Signature Date(Required) MM slash DD slash YYYY
