Field Trip Report Who and where you went. Name(Required) First Last Email(Required) Phone(Required)ConsentBy signing my name, I am indicating that I have read the ESA policy guidelines for Northland College. If approved for an ESA accommodation, I agree to abide by the ESA requirements as outlined above. I understand that signing this is not an indication of approval for an ESA but rather one step in the process.Yes(Required) I agree to the Northland's ESA policy guidelines. Date(Required) MM slash DD slash YYYY Signature(Required)Your name typed in full serves as a legal signature.Emergency ContactIf I am granted approval for an ESA, and in case of an emergency, I give permission to contact the following individual who has agreed to care for my ESA until I am able to care for the animal or have made other arrangements for the animal’s care.Emergency Contact Name(Required) First Last Emergency Contact Phone(Required)Emergency Contact Email Be certain to tap the SUBMIT button. You will receive an email confirmation soon after submitting the form. If you do not receive an email confirmation, it means your form did not go through and you need to resubmit.CommentsThis field is for validation purposes and should be left unchanged.
