Service Animals (SA) / Emotional Support Animals (ESA)

Campus Housing Intake Form

Service Animals: Under the ADA, a service animal is defined as a dog that has been individually trained to do work or perform tasks for an individual with a disability. The task(s) performed by the dog must be directly related to the person’s disability.

  • The dog must be trained to take a specific action when needed to assist the person with a disability. For example, a person with diabetes may have a dog that is trained to alert them when their blood sugar reaches high or low levels. A person with depression may have a dog that is trained to remind them to take their medication. Or, a person who has epilepsy may have a dog that is trained to detect the onset of a seizure and then help the person remain safe during the seizure.
  • Under the Texas Human Resources Code Sec. 121.006, any person who misrepresents an animal as a service animal is guilty of a misdemeanor, which is punishable by a fine of up to $300 and 30 hours of community service.


Emotional Support Animals: This term is used to describe animals that provide comfort just by being with a person. Because they have not been trained to perform a specific job or task, they do not qualify as service animals under the ADA.


Note: All approved service and emotional support animals must comply with applicable laws regarding animals, including the City of Denison Code of Ordinances, Chapter 4-Animals.

 

Student Information

Please provide the following information about yourself.

 

Last name, First name

 
 

Please enter your Grayson College student email address below. We will respond to Grayson College student email addresses only. (Student email addresses end with @vikings.grayson.edu)

 
Phone
 

Please list the degree or certificate you are seeking.

 
 

Student's Diagnosis and Documentation (ESA Requests Only)

Student's medical documentation is required for Emotional Support Animal requests.


Grayson College requires documentation of the student’s current condition from the treating licensed clinical professional or healthcare provider.

  • This provider must be thoroughly familiar with the student’s condition and functional limitations and must make a direct connection to the requested animal based on the student’s current functional limitations.
  • This provider must not be a relative of the student.
  • This provider must be licensed within the student’s home state or state of permanent residence where the student was diagnosed/treated.
  • This provider is determining their patient's need for the ESA and must be familiar with the patient and their interactions with the requested animal.
  • ESA certification is not required or recommended.


All medical documentation is kept strictly confidential and should be delivered by the student to the Accessibility Services Office either in-person or by email to hodgej@grayson.edu.

 

Animal Information

Please provide the following information about your animal and your needs.

 

Is your animal a Service Animal or an Emotional Support Animal?

 

How long has this animal been an SA or ESA for you? Please indicate whether this is years or months.

 

What is your animal's name on documents provided to you by the breeder or the animal shelter?

 

If you have changed your animal's name, what is its new name?

 

Dog or Cat

 

If your animal is a mixed breed, list the predominate breeds.

 

How old is your animal?

 

Is your animal a male or female?

 
 

Animals must be current on their vaccinations and disease-free before approval to move them into the residence hall.

 

Animals must be housebroken or litter box trained before approval to move them into the residence hall.

 

Animals must be in their crates when their owner is not in their room.

 

Please upload a current picture of your animal. You may also upload vaccination records and other documents as needed.

Drop your files here
 

Emergency Contact Information

Roommates and other friends in housing are not required or expected to care for your animal in your absence. Your animal cannot stay in your room or the rooms of other residents overnight if you are not present.


Should an emergency arise in which you are unable to care for your animal, Grayson College Housing Staff will need to contact someone you trust for the care of your animal.

  • Your animal will need to be picked up by this person in a timely manner.
  • Your animal can return to your room when you are in residence and able to provide for its care.
  • If GC Housing Staff cannot reach the persons listed below after reasonable attempts within a 24 hour period, your animal may be housed at a kennel in the area at your expense.
 

Please provide the names and phone numbers of two people who will be available to provide this service for you. If you will be using a local professional service for this, please provide the name and website of the service or kennel as well (check with the service provider or kennel for their requirements before listing them here).

 
 

Student Agreement

 

Your request for an ESA in Housing should include documentation of your needs. Documentation from your treating licensed clinical professional or healthcare provider should specifically outline your current condition. Your provider must be thoroughly familiar with your condition and functional limitations and must make a direct connection to the requested ESA based on your current functional limitations.

  • Your documentation is required in the Accessibility Services Office located in the Testing Center on the Main Campus (SSC201) before approval to move your animal into Housing.


Under the ADA, owners of Service Animals are exempt from medical documentation requirements.

 

Current veterinarian records are required in the Accessibility Services Office located in the Testing Center on the Main Campus (SSC201) before approval to move your animal into Housing. Updated records should be provided annually.

 

Please read the Service and Assistance Animal Procedure document carefully to ensure you understand the procedures before signing this document.

 
 
 

By entering your name below, you are agreeing to abide by the procedures for animal care in the residence halls.