CLRP

REQUEST FOR REASONABLE ACCOMMODATION

REQUEST FOR REASONABLE ACCOMMODATION


Name: ___________________________________________________________________________

Address: ___________________________________________________________________________

___________________________________________________________________________

Phone: ___________________________________________________________________________


1. The following member of my household has a disability:

___________________________________________________________________________

2. Please provide the following change or changes so that the person listed above can live here as easily and successfully as the other residents.


• A change in my apartment, other part of the housing complex. Specifically:

___________________________________________________________________________


• A change in the following rule or the other way you do things (I understand that I may as for changes in how I meet the terms of the lease, but that everyone must continue to meet the terms of the lease): _________________________________________________________

___________________________________________________________________________

3. I need this reasonable accommodation because: _________________________________

___________________________________________________________________________

4. You may verify the need for this request by contacting:

Name: _______________________________________________________________

Address: _______________________________________________________________

Phone: _______________________________________________________________

I give you permission to contact the above individual for purposes of verifying that I or a family member needs the reasonable accommodation requested above.


Signed: ___________________________________________ Date: _____________________