VAWA Professional Certification

Professional Certification of Domestic Violence, Dating Violence, Sexual Assault or Stalking

This top section is to be completed by the program participant seeking VAWA protections.

Program Participant: [WRITE PARTICIPANT’S NAME]

Date: [WRITE DATE]

Provider of Housing or Rental Assistance: [WRITE NAME OF PROVIDER]

Deadline to Submit This Form (if applicable): [WRITE DEADLINE]

VAWA Protection Requested:

[CHOOSE ONE OF THE FOLLOWING]

Defense of eviction, termination, or denial   

Emergency Transfer

VAWA Authorization to Release Information

Authorization to Release Information for Victims of Domestic Violence, Dating Violence, Sexual Assault or Stalking

Before you authorize a program to share any of your confidential information with another agency or person, program staff will discuss potential risks and benefits of sharing your confidential information. If you decide you want the program to release some of your confidential information, you can use this form to choose what is shared, how it is shared, with whom, and for how long.

Verification of Disability Letter for Reasonable Accommodation

When a person’s disabilities prevent them from using or enjoying their housing in the same way as people without disabilities, they can ask for reasonable changes in their housing. This letter template can be used if your housing provider or landlord asks you to have your doctor or another service provider verify that you need the change. It can be from someone who knows about you and your disability, or from someone who knows about the change that you need. Or you can use this letter as a model to write your own letter.

Sample Reasonable Accommodation Denial Letter

When a person’s disabilities prevent them from using or enjoying their housing in the same way as people without disabilities, they can ask for reasonable changes in their housing. This letter template can be filled out and sent to the landlord if they have denied your written request for a reasonable accommodation. Or you can use it as a model to write your own letter. You should keep a copy of the letters that you send. Learn more on this page of our website.

Use this text or the PDF, below.