A Property Managed by Eden Housing Management, Inc.

REQUEST FOR REASONABLE ACCOMMODATION/MODIFICATION

Date of Request: Date of Receipt of Request by Manager:

Name:______Phone:

Address:

POLICY: It is the policy of Eden Housing, Inc., Eden Housing Management, Inc. and Eden Housing Resident Services, Inc. not to discriminate against any person because of that person’s race, color, religious creed, sex (gender), sexual orientation, marital status, national origin, ancestry, familial status (households with children under the age of 18), source of income, disability, medical condition or age. Color or “ethnic group identification” means the possession of the racial, cultural or linguistic characteristics common to a racial, cultural or ethnic group, or the country or ethnic group from which a person or his or her forebears originated.

  1. I have, or a member of my household has, a disability as defined below:

A physical or mental impairment that limits one or more major life activities such as walking, climbing, talking, breathing, hearing, seeing, etc., or a mental impairment that limits a person from using the facilities or programs provided by the property.

Name of household member with disability: ______

  1. As a result of the above-named person’s disability, I request the following change or changes so that (the person listed) has the same opportunity to live here as successfully as the other residents.

______

______

______

______

Please note: Eden Housing will consider making physical changes to your apartment or common areas, and will consider making changes to policies, practices, rules or activities if the changes are necessary because of your disability. The types of accommodations/modifications that Eden Housing has made include:

  • Adding a ramp where there are stairs;
  • Widening doors inside a unit;
  • Permitting rent to be paid by mail rather than in person.
  1. I need this reasonable accommodation/modification so that I can:

______

  1. Initial one or both of the following:
  1. _____I understand that I must give you a health/mental health professional’s letter that verifies my need for

accommodation/modification.

  1. _____You may verify that I have a disability and my need for this request by contacting:

Physician/Licensed Health/Mental Health Professional’s Name: ______

Title:

Address:______

Phone:______

I give you permission to contact the above individual(s) or organization(s) for purposes of verifying that I have or a family member has a disability and needs the reasonable accommodation/modification requested above. I understand that the information you obtain will be kept completely confidential and will be used solely to determine if you will provide an accommodation/modification.

Signed: ______Date: ______

  1. If you asked for a change to your apartment or to the common areas of the property, please use this space to list any company or organization that might help us locate or build anything special that you need. (If you don’t know of any, we will try to get this information ourselves.)

______

______

Eden Housing staff will consider this request and provide a written answer to you within a few days but no longer than 14 calendar days of the date the Manager received this request.

It is the policy of Eden Housing, Inc., Eden Housing Management, Inc. and Eden Housing Resident

Services, Inc. not to discriminate against any person because of that person’s race, color, religious creed,

sex (gender), sexual orientation, marital status, national origin, ancestry, familial status (households with children under the age of 18), source of income, disability, medical condition or age. Color or “ethnic group identification” mean s the possession of the racial, cultural or linguistic characteristics common to a racial, cultural or ethnic group, or the country or ethnic group from which a person or his or her forebears originated.