Sample Verification for Reasonable Accommodation/Modification
Re: (Name) request for a (type of accommodation, example: a reserved accessible parking space adjacent to apartment).
Please accept this correspondence as verification that:
- I am a (example: licensed medical doctor) .
- I have treated (name) since (date) for a (physical, mental, etc) condition. I have evaluated and/or treated him/her (number) times in the last twelve months.
- (Name) is a person with a disability as defined by the Washington Law Against Discrimination (RCW 49.60).
- His/her disability affects his ability to (insert).
- Allowing the accommodation of (insert) is necessary to afford (name) the opportunity to access and fully use and enjoy his/her home.
Please approve (name’s) request for (accommodation/modification request).
Signature: (Dr. so and so)
Printed Name: ____________________
Professional Title: ______________
Name of Clinic, Hospital, etc.: _______________________________
Phone Number: ____________________________
Fax Number: ______________________________