W Volunteers of America & a REQUEST FOR A REASONABLE ACCOMMODATION OR MODIFICATION Please complete and return this form tw, tame of property}, to ve submitted to the Section 504 Coordinator, if you have & request for reasonable accommodation or ‘modification which you would like to make due to a disability. We will attempt to make a decision within thirty (30) days of our receipt of the attached Disability Verification Form. We will notify you if additional information or verification is needed; or if we could discuss other means of meeting your needs. The accommodation or modification | request is as follows: ae Veg mata a bf my pants 0 Sook. Quan Wwoabhing or, aatele) 2 Zh. eae D J { Date: 2ef 5 Time: Unit #: j Resident/Applicant Name: ~ : / tie TT a Telephone: ps se eae Signature: _, Curered be 097 amg Maghib foxbs li te oD, Cured Ae # Ae reek yf Geb beg one heb ido oomph. AhLS ho bern, : t pe tdabl cant elep dori, oor Dot ; Dn ioctl BE EO? 1? ethene asta aeY Volunteers of America TREATMENT PROVIDER VERIFICATION STATEMENT 1 is ‘Sled as defined below? Ye 5 (ve3)n0) 2. Does the household member require requested accommodation? YES (yes/no) 3. Please describe any other modification or accommodation that could meet the Resident/Applicant’s needs in place of requested accommodation. For example, if there is a less expensive way to assist the household member cope.with his/her disability, please detail below: dae bfntre! aT clefetmites féctrediictty’ ery Afited? poe fue He walk Cred Shas Aispnees Lew fe te ke 2a Th Pato a The Chad wt Smt h ney ir. tra for Lee behalf Signature of Treatment Provider: Name of Treatment Provider/Agency: « (Please Print or Type) Address: City/State/Zip: Se : Phone: z Date: eeGY Volunteers of Ameri a DISABILITY VERIFICATION FORM. TO: (Name of Verification Source) (Address of Verification Source) (Telephone) RE: ns —— (Name of Resident /annticant requesting accommodal (Address of Resident/applicant) VERIFICATION REQUEST \We are required to verify that the household member named above is disabled under federal [aw and eligble for the accommodation or modification requested. We would appreciate your cooperation in completing and returning the attached Provider Verification Statement to us a¢ S007 as possible. A consent to Release Information form signed by the Resident/Applicant is enclosed with the Verification Request. If you have any questions you may contact: ee eee, ae The Resident/Applicant listed above has requested the following accommodation or maaification based ypon a disability: Name Title DateVolunteers of America: National Housing Corporation May 13, 2016 Tam in receipt of your second request (possible appeal) for a Reasonable Accommodation, dated April 19, 2016. You have provided a note from a medical professional stating that you have a disability and you are requesting to be allowed to smoke on your patio, outside your unit. Regarding your original request to be accommodated because of a physical mobility issue, we have chosen to accommodate this by placing a Smoking Hut within 20 feet of your patio. Regarding this additional request to be allowed to smoke on your patio because it is a ‘stress relieving activity’, there is no medical evidence that smoking alleviates anxiety. Without a clear nexus between a disability and the accommodation, | am denying your request. Sincerely, Regional Housing Manager A Ministry of Service ‘Volunteers of America National Housing Corpo Rev. Rebecea Dixon, Regional Housing Manager 7 Konnarock Cirele Greenville, SC 29617 Cell 864-483-1748, ‘dixondvoa org www voearofinas ore