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HUD Certification Form for Domestic Violence, Stalking, Sexual Assault, etc.

If you are seeking VAWA protections from your housing provider, your housing provider may give you a written request that asks you to submit documentation about the incident or incidents of domestic violence, dating violence, sexual assault, or stalking. In response to this request, you or someone on your behalf may complete the attached form and submit it to your housing provider. The attached form was created by the U.S. Department of Housing and Urban Development and can be used by survivors of domestic violence, dating violence, stalking, or sexual assault to submit to their housing provider for protections under the Violence Against Women Act (VAWA).