SMC Service & Emotional Support Animal Registration Form

Please complete this form to register your approved Service or Emotional Support Animal with SMC's Accessibility Resources office.

Student's Name Student's Name * First Last
SMC ID #
What type of animal has been approved for you? *

What type of animal has been approved for you? Service Animal Emotional Support Animal
Animal Type (i.e., dog, cat, etc.) *
Animal's Name *
Animal's Breed (type "N/A" if not applicable) *
Animal's Gender *
Is the animal spayed or neutered? *

Is the animal spayed or neutered? Yes No Doesn't apply
Has your animal received full vaccinations? *

Has your animal received full vaccinations? Yes No Other Other
Who is your veterinarian? Who is your veterinarian? * Title First Last Suffix
What is the name of the veterinarian's practice? *
What is your veterinarian's phone number? What is your veterinarian's phone number? * - ### - ### ####
Please upload a recent picture of your animal.

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