Vermont Human Rights Commission Questionnaire for Housing Complaints

Your answers to this questionnaire are confidential pursuant to 9 V.S.A. §4555(a). Please print or type your responses. If you have any questions or require assistance while filling out this form, don’t hesitate to contact the HRC at 1-800-416-2010 (Toll Free VT) or 802-828-1625 or by email at human.rights@vermont.gov.

Information about you

2. Establishing Jurisdiction

B. Housing action action upon which your complaint is based

3. Respondent Information

I understand that the information in this questionnaire may be shared, in whole or part, by the Vermont Human Rights Commission (HRC) with the U.S. Department of Housing and Urban Development and the Respondent identified above.

Additional Questions for Housing Discrimination Claims: Please answer any or all of the following applicable questions either directly on this form or on another sheet of paper. Additionally, you are invited to provide any further information or documents you believe would be helpful.

Additional Documents

Complete