4. By signing below, I authorize BangorHousing to verify that I or a member of my household has a disability and have a need for the specific accommodation requested. I also authorize the provider/practitioner listed below to complete and return the Reasonable Accommodation Verification Form to BangorHousing and to answer any other questions BangorHousing may have concerning this request. Information obtained under this authorization is limited to information from the last 12 months.
In order to verify the information in this Request Form, BangorHousing may contact: