New Submission

Datefield type date
Is the individual requesting use of a service animal a student, employee, parent, or other?*field type radio button
Is the individual requesting use of a service animal a student, employee, parent, or other?StudentEmployeeParentOther

Student Number*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Schoolfield type single line
Input blocked. Maximum character limit of 4000 characters reached.
Gradefield type single line
Input blocked. Maximum character limit of 4000 characters reached.
First Name*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Middle Namefield type single line
Input blocked. Maximum character limit of 4000 characters reached.
Last Name*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Email*field type email
Does this individual already have a support plan under any of the following laws?*field type checkbox
Does this individual already have a support plan under any of the following laws?Section 504Individuals with Disabilities in Education Act (IEP)Health PlanNo support plan in place

Employee Email*field type email
Must be your @d93.k12.id.us email address
First Name*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Middle Namefield type single line
Input blocked. Maximum character limit of 4000 characters reached.
Last Name*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Does this individual already have a support plan under any of the following laws?*field type checkbox
Does this individual already have a support plan under any of the following laws?ADA (Americans with Disabilities Act)No support plan in place

First Name*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Last Name*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Email*field type email

In what schools or other locations will the service animal be used?

	Location*field type drop-down	Other Description*field type single line	Prinicpal Emailfield type single line	Emailfield type single line
Row 1×	Location*field type drop-down	Other Description*field type single line Input blocked. Maximum character limit of 4000 characters reached.	Prinicpal Emailfield type single line Input blocked. Maximum character limit of 4000 characters reached.	Emailfield type single line Input blocked. Maximum character limit of 4000 characters reached.	×

Is the dog a service animal required because of a disability?*field type radio button
Is the dog a service animal required because of a disability?YesNo
Has the dog been trained to perform a specific task or work?*field type radio button
Has the dog been trained to perform a specific task or work?YesNo
What tasks or work has the dog been trained to perform?*field type multi line
Additional Informationfield type multi line
Signature*field type signature
Datefield type date

Birth Datefield type date
School Yearfield type single line
Input blocked. Maximum character limit of 4000 characters reached.
School Numberfield type single line
Input blocked. Maximum character limit of 4000 characters reached.
DCIDfield type single line
Input blocked. Maximum character limit of 4000 characters reached.
SSNfield type single line
Input blocked. Maximum character limit of 4000 characters reached.
Last 5field type single line
Input blocked. Maximum character limit of 4000 characters reached.
This field contains a calculation error.
References: SSN