Request an Accommodation/ Modification

Your Name (required)

Your Email (required)

Name of Property

Address line 1

Address line 2

City, state, zip

Property management phone number:

Name of the landlord or property manager:

Please describe in 1 or 2 complete sentences how your disability impacts your life:

A reasonable accommodation is:
A change to the rules, policies, practices, or services so that a person with a disability will have an equal opportunity to use and enjoy a dwelling unit or common space. For example, advanced notice of maintenance repairs.

A reasonable modification is:
A structural change made to existing premises, occupied or to be occupied by a person with a disability, in order to afford such person full enjoyment of the premises. For example, having grab bars installed in the shower.

What reasonable accommodation or modification do you need to be able to enjoy your premises? Please describe each request separately and in complete sentences:

Request 1:

Request 2:

Request 3:

Any other comments you would like to add about this request?

If your disability is not visible, you must provide a third party letter verifying your need for each accommodation or modification you are requesting. Please select one of the following:
My disability is visible so no third party verification is neededMy disability is not visible and I've enclosed third party verificationMy disability is not visible and I will provide third party verification once I have it.