Registry for Service Animals

1. Date of Arrival on Campus Required

2. Date of Departure from Campus Required

3. Full Name Required

4. Campus Residence Bldg. & Room Required

5. Campus Phone Required

6. Home Address

7. City

8. State

9. Zip

10. Home Phone

11. Cell Phone

12. Email Required

13. Status on Campus Required

14. Name of Animal

15. Type of Animal Required

16. Services animal Provides

17. Information about the Service Animal

18. Identifying tags or accessories

19. Date of most recent vaccinations

20. Training agency (Send copy of certificate to Disability Services, Box 3019)

21. Maintenance Plan

22. Other Important Information