U.S. HUD Violence Against Women Act Forms

As a recipient of U.S. HUD Community Development Block Grant (CDBG) funds through the Vermont Community Development Program (VCDP), the City of St. Albans is required to make the following forms and information available for residents of CDBG-assisted and other relevant housing.

If you wish to use these forms, please be aware that the City is not the intended recipient. For the most part, they are for submission to your housing provider or others.

Forms and Information

Violence Against Women Act Forms Forms and more information, including .docx versions.

Your Rights Under the Violence Against Women Act Including how to file a complaint.

Form HUD-5380: Protections for Victims of Domestic Violence, Dating Violence, Sexual Assault or Stalking [pdf file]

Form HUD-5381: Model Emergency Transfer Plan for Victims of Domestic Violence, Dating Violence, Sexual Assault, and Stalking [pdf file]

Form HUD-5382: Certification of Domestic Violence, Dating Violence, Sexual Assault, or Stalking [pdf file]

Form HUD-5383: Emergency Transfer Request for Victims of Domestic Violence, Dating Violence, Sexual Assault, or Stalking [pdf file]

Form HUD-5384: VAWA Emergency Transfer Data Collection Form [pdf file]