File: EJ-E-1 - Appendix A - DRAFT File: EJ-E-1 - Appendix A - DRAFTRequest to be Accompanied by Service Animal
(Annual Request Required)
Date: ______________ Student Name: __________________________________________________
Employee Name: __________________________ Owner/Handler: _____________________________
Location: __________________________________________________________________________
What work or task(s) has the service animal been trained to perform? Describe:
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Type of Animal: ___Dog ___Miniature Horse
Name of Animal: ___________________________________
Approved by: _____________________________________
Signature
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Title
Students should submit this request to their building principal/administrator, and employees should submit this request to the district's 504 Compliance Officer. Completed request forms should be maintained in the student's cumulative file or the employee's personnel file, whichever is applicable.
Adopted: March 2, 2017
Revised: November 8, 2018