St. Clair County Community College

High-quality, affordable education

Emotional Support Animal

Emotional Support Animal

Provider Request for Information form

Proposed ESA Information:

The above-named student has indicated that you are the (physician, psychiatrist, social worker,and/or mental health worker) who has suggested having an Emotional Support Animal (ESA) incampus housing will be helpful in alleviating one or more of the identified effects of the student’s disability. So that we may better evaluate the request for this accommodation, please answer the following questions (complete information will better assist in the decision making process for the ESA Request):
Information about the Student’s Disability: (A person with a disability is defined as someone who has “a physical or mental impairment that substantially limits one or more major life activities”).

Information about the Proposed ESA

Important of ESA to student’s well-being

Thank you for taking the time to complete this form. If the college needs additional information, the college may contact you at a later date. The college recognizes that having an ESA in campus housing can be a real benefit for someone with a significant mental health disorder, but the practical limitations of our housing arrangements make it necessary to carefully consider the impact of the request for an ESA on both the student and the campus community.