Service Dog Acknowledgment and Emotional Support Animal Approval Application
  1. Please use this form to request acknowledgment of a service dog or approval of an emotional support animal in campus housing. If you need assistance completing the form, please email housingaccommodations@berkeley.edu, or call (510) 642-4108. More information can be found in the ESA and Service Dog Information Sheet (PDF).
Email *
Owner's First and Last Name *
Owner's Phone Number *
Owner's Email Address *
Application Type *
Student ID number or SelfReg ID number *
User's name (if different)
User's contact information (if different)
Type of animal *
Is this an Emotional Support Animal or Service Dog? *
Is the animal spayed or neutered? *
Name of animal *
Age of animal *
I confirm that this animal is current on all vaccinations including rabies, if applicable.  
 *
Required
Date of rabies vaccination, if applicable
MM
/
DD
/
YYYY
I have read and agree that the Animals on Campus policy rules apply to this animal. I acknowledge that dogs and cats must be 6 months of age and have all required vaccinations.
 *
Required
All dogs (including Service Dogs) require a local license as designated by the local authorities. Please refer to the relevant local authority website (Berkeley, Albany, Emeryville). If applicable, I will provide proof of licensing to housingaccommodations@berkeley.edu within six weeks.
 *
Required
I agree that the animal will be contained within the private residential area (room, suite, or apartment) at all times, except when transported outside the private residential area in an animal carrier or controlled by leash or harness (maximum length of 6 feet).   
 *
Required
I agree that I may be charged if this animal damages campus property.   
 *
Required
To my knowledge this animal does not have ticks, fleas, or any disease that would endanger animals or people.   
 *
Required
Is this a new application or a reacknowledgment of guidelines? *
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