______Consumer Name_______ has authorized me to verify his/her need for a reasonable accommodation in housing due to the presence of a disability. In my professional opinion, ______Consumer Name_______ has a physical or mental disability that substantially limits one or more major life activities. I base my opinion on __________ (please be specific)_________ _______________.
As a reasonable accommodation to his/her disability, ______Consumer Name_______ needs ____________ (physical accommodations, service requirements or other reasonable accommodations) ___________________ to assist him/her with housing?
I certify that the above information is based on my professional opinion, and is true and correct to the best of my knowledge.
Name (print or type) __________________________