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Working Together for Justice

All Forms

Advance Directive Forms

Send this form and your Advance Directive to the Vermont Advance Directive Registry to store it electronically so hospitals or other providers have quick access to it in an emergency.
Use this form to create an Advance Directive for your health care.  
Use this form to create an Advance Directive for your health care.  

Complaint Forms

Use this form to file a complaint with the Human Rights Commission if you or your child has experienced discrimination at your child's school.  
Use this form to file a consumer complaint in Vermont, for example if a debt collector does something they're not supposed to.  
Fill out this form if you have been discriminated against at work in Vermont.  
If you are an applicant or employee at the State of Vermont, use this employment discrimination form.
Use this form to file a complaint with the FTC.  
If you think your health information privacy rights have been violated, you can file a complaint with the U.S. Department of Health and Human Services.
If you believe that your health information privacy rights have been violated by the Vermont Agency of Human Services, you can file a complaint.
HUD (the U.S. Department of Housing and Urban Development) handles violations of federal housing law, including discrimination violations.
Use this form to file a complaint about your insurance with the Department of Financial Regulation.
If you have a complaint about a medical provider other than a doctor, physician's assistant or podiatrist, use this form.
Use this form to file a complaint about a doctor, physician's assistant or podiatrist.
To file a complaint with the Human Rights Commission, fill in this housing complaint form.  

CourtFormPrep

Use this CourtFormPrep form to file a request for the court to order the other party in a small claims case to give you and the court more information about their financial situation.
Use this CourtFormPrep form to fill out Small Claims Financial Disclosure paperwork to tell the court about your financial situation.  
Use this income and expense affidavit when filing for divorce in the state of Vermont. 
Use this property and asset affidavit when filing for divorce in the state of Vermont. 
This CourtFormPrep program will help you fill out the paperwork you need to fill out an inventory for an estate in probate court.  
This CourtFormPrep program will help you fill out the paperwork you need to open an estate in probate court.  
Use this CourtFormPrep program to prepare a motion to enforce your child support order in the state of Vermont. 
Use this CourtFormPrep program to prepare a motion to modify (change) your child support order in the state of Vermont. 
Use this CourtFormPrep form to respond to a divorce, civil union dissolution or legal separation complaint from your partner. 
Use this CourtFormPrep form to start a divorce, civil union dissolution or legal separation in the state of Vermont. 
Use this CourtFormPrep form to file a Small Claims Complaint. 

Debt Collection Forms

Use this form to file a consumer complaint in Vermont, for example if a debt collector does something they're not supposed to.  
You can use this form to stop collection agencies from calling you at work. However, the company you owe the money to can still call you.
Use this form letter to tell debt collectors to stop calling you and tell them that your income is exempt from collection.

Disaster Forms

The SBA provides low interest disaster loans. Businesses can apply if they suffered physical property damage or economic injury, even if not located in the disaster area.
Use this form to amend last year's return. For example, use this form if you are claiming a loss for the previous year due to a natural disaster.  
To request an IRS account transcript (computer printout), use this form. You can also use the short form, 4506T-EZ.
To request copies of tax returns, complete this form. Copies of past tax returns are free for people affected by a federally declared disaster area.
This is the short form version of Form 4506-T. Use this form to ask for a free tax transcript. It can be used in the foreclosure mediation process.
To calculate and report casualty losses, such as after a natural disaster, you will need to complete this form.  
If you have a new address, complete this form to notify the IRS. Updating your address with the post office does not update it with the IRS.

Family Forms

Use this link to apply for these Vermont programs: 3SquaresVT, Fuel Assistance, Reach Up and Essential Person.
Use this form to file a complaint with the Human Rights Commission if you or your child has experienced discrimination at your child's school.  
Use this form to file for legal separation in Vermont if you and your spouse do not have children.  
Use this form to file for legal separation if you and your spouse have children.  
Use this form to order a civil union dissolution certificate from the Department of Health.  
Use this form when you are going through a divorce in the state of Vermont. 
If you are the defendant in a divorce case and have no children, file either a Notice of Appearance or Answer and Counterclaim within 20 days of being served with the court papers.
Use this form if you are the defendant in a divorce case and have children.
Use this income and expense affidavit when filing for divorce in the state of Vermont. 
Use this property and asset affidavit when filing for divorce in the state of Vermont. 
HUD (the U.S. Department of Housing and Urban Development) handles violations of federal housing law, including discrimination violations.
If you cannot afford the court filing fee, bring this form with you to the courthouse. The clerk may be able to waive the fee for you so you don't have to pay.
Use this form to initiate a Motion to Modify to change your child custody order.  
This CourtFormPrep program will help you fill out the paperwork you need to fill out an inventory for an estate in probate court.  
If you ask someone to stop coming into your home but the person keeps coming anyway, you can use a Notice Against Trespass to keep the person out.  
If you are the defendant in a divorce case and have no children, file either a Notice of Appearance or Answer and Counterclaim within 21 days of being served with the court papers.
This CourtFormPrep program will help you fill out the paperwork you need to open an estate in probate court.  
Use this CourtFormPrep program to prepare a motion to enforce your child support order in the state of Vermont. 
Use this CourtFormPrep program to prepare a motion to modify (change) your child support order in the state of Vermont. 
Use this form when you are filing for non-resident divorce or dissolution of a civil union. 
An affidavit is a sworn statement. The Relief from Abuse Affidavit is filed with your request for a Relief from Abuse Order.
This form is used to give a sworn statement about what happened to cause you to file a Relief from Abuse Complaint on behalf of a child.
A Relief from Abuse Order is a court order that tells your abuser they can't abuse you anymore. To get one, file this form and a Relief from Abuse Affidavit.
This form is used to ask for a Relief from Abuse Order on behalf of a minor child. This form must be filed with the Relief From Abuse Affidavit on Behalf of a Child.
Use this CourtFormPrep form to respond to a divorce, civil union dissolution or legal separation complaint from your partner. 
Use this CourtFormPrep form to start a divorce, civil union dissolution or legal separation in the state of Vermont. 

Foreclosure Forms

Complete this form if you receive a foreclosure Complaint. You must file a written Answer within 20 calendar days of when you received the Complaint.  
If you are a tenant and your landlord is being foreclosed on, use this form to enter an appearance in the foreclosure case and to get notices about the foreclosure case.  
If you cannot afford the court filing fee, bring this form with you to the courthouse. The clerk may be able to waive the fee for you so you don't have to pay.
This is the short form version of Form 4506-T. Use this form to ask for a free tax transcript. It can be used in the foreclosure mediation process.

Guardianship Forms

Use this form to ask for the appointment of a guardian for an adult.  
Use this form to initiate a voluntary guardianship for yourself if you are an adult.  

Medicaid Forms

If you are requesting a Medicaid coverage exception, you and your doctor will need to fill out these forms.
If you are applying only for Prescription Assistance, use this form. If you are applying for other medical programs as well, apply online through DCF. 

Medicare Forms

This form is used to say who can represent you when dealing with Medicare.  
Use this form to allow Medicare to give your personal health information to someone other than you.  
Use this form to request a Medicare prescription drug coverage determination.  
Use this form to request medical payment from Medicare.  
If you are applying only for Prescription Assistance, use this form. If you are applying for other medical programs as well, apply online through DCF. 

Power of Attorney Forms

Use this form to revoke (remove) Power of Attorney from your agent.  
Use this form to give someone Power of Attorney for your financial affairs. This means that this person is allowed to help you manage your money and property.  

Prescription Drug Forms

Use this form to request a Medicare prescription drug coverage determination.  
If you are applying only for Prescription Assistance, use this form. If you are applying for other medical programs as well, apply online through DCF. 

Public Benefits Forms

If you disagree with the Social Security Administration's decision, use this letter to ask for a hearing.  
Use this form to apply to the Green Mountain Power Energy Assistance Program for help providing electricity to your home.  
Use this form to apply to the Vermont Gas Energy Assistance Program for help providing gas to your home.  
Use this link to apply for these Vermont programs: 3SquaresVT, Fuel Assistance, Reach Up and Essential Person.
You can request a fair hearing if your request was denied or approved at less than you asked for, or if your amount goes down or stops.  
Do you have medical expenses? Do you have a disability or are you over 60? Should you get more food stamps?  
You have the right to appeal decisions from the Department for Children and Families (DCF) about your benefits.  Use this form to appeal.
Use this form to ask for a hearing if someone refuses to give you rent assistance or if your rent assistance or Section 8 is being stopped.  
If you cannot afford the court filing fee, bring this form with you to the courthouse. The clerk may be able to waive the fee for you so you don't have to pay.
Use this form to apply for housing/rental assistance in Burlington.  
If your Reach Up grant recently went down (decreased), you can appeal with this Form Letter.  
To find out if you’re eligible for Fuel Assistance to help pay for your home heating bills, fill out this application.
If you are applying only for Prescription Assistance, use this form. If you are applying for other medical programs as well, apply online through DCF. 

Relief from Abuse

An affidavit is a sworn statement. The Relief from Abuse Affidavit is filed with your request for a Relief from Abuse Order.
This form is used to give a sworn statement about what happened to cause you to file a Relief from Abuse Complaint on behalf of a child.
A Relief from Abuse Order is a court order that tells your abuser they can't abuse you anymore. To get one, file this form and a Relief from Abuse Affidavit.
This form is used to ask for a Relief from Abuse Order on behalf of a minor child. This form must be filed with the Relief From Abuse Affidavit on Behalf of a Child.

Renter (Tenant) / Landlord

Use this form to apply to the Green Mountain Power Energy Assistance Program for help providing electricity to your home.  
Use this form to apply to the Vermont Gas Energy Assistance Program for help providing gas to your home.  
Use this link to apply for these Vermont programs: 3SquaresVT, Fuel Assistance, Reach Up and Essential Person.
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.
Use this form to answer what your landlord claims about you if your landlord is trying to evict you.  
Use this form to file a counterclaim against your landlord during the eviction process.  
If you are a tenant and your landlord is being foreclosed on, use this form to enter an appearance in the foreclosure case and to get notices about the foreclosure case.  
Use this form to ask for a hearing if someone refuses to give you rent assistance or if your rent assistance or Section 8 is being stopped.  
HUD (the U.S. Department of Housing and Urban Development) handles violations of federal housing law, including discrimination violations.
If you cannot afford the court filing fee, bring this form with you to the courthouse. The clerk may be able to waive the fee for you so you don't have to pay.
Use this letter to let your landlord know about the law about coming into your apartment.   
If you ask someone to stop coming into your home but the person keeps coming anyway, you can use a Notice Against Trespass to keep the person out.  
Use this form to apply for housing/rental assistance in Burlington.  
You can print this form letter, fill in the information about the repairs needed at your home, and send it to your landlord.
If it's been 14 days since you told your landlord you moved out or you believe your landlord wrongfully kept your security deposit, use this form to ask your landlord to return it.
To find out if you’re eligible for Fuel Assistance to help pay for your home heating bills, fill out this application.
To file a complaint with the Human Rights Commission, fill in this housing complaint form.  
Your landlord has to give you this form by 1/31 (if your apartment/house has more than one rented unit) or a reasonable amount of time after you ask for it (if there's only one unit).
Use these forms from the Vermont Department of Taxes to claim the renter rebate.  

Small Claims Forms

Use this CourtFormPrep form to file a request for the court to order the other party in a small claims case to give you and the court more information about their financial situation.
Use this CourtFormPrep form to fill out Small Claims Financial Disclosure paperwork to tell the court about your financial situation.  
If you cannot afford the court filing fee, bring this form with you to the courthouse. The clerk may be able to waive the fee for you so you don't have to pay.
Use this form to give the court your contact information. Send them a new form if something changes. The court can then send you copies of any notices, court dates and paperwork filed in court.
Use this form to respond to (answer) a small claims complaint that someone filed against you.  
This form is for disclosing (telling the court about) your finances in a small claims case.  
Use this CourtFormPrep form to file a Small Claims Complaint. 

Tax Forms

Use this form to amend last year's return. For example, use this form if you are claiming a loss for the previous year due to a natural disaster.  
To request an IRS account transcript (computer printout), use this form. You can also use the short form, 4506T-EZ.
To request copies of tax returns, complete this form. Copies of past tax returns are free for people affected by a federally declared disaster area.
This is the short form version of Form 4506-T. Use this form to ask for a free tax transcript. It can be used in the foreclosure mediation process.
If you have a new address, complete this form to notify the IRS. Updating your address with the post office does not update it with the IRS.
Instructions and online forms to file your federal income tax return for free.  
Links to all IRS tax forms and their instructions.
This set of forms is used to tell the state of Vermont that you live in the house you own (homestead declaration) and to ask for help paying your property taxes (property tax adjustment claim).
Your landlord has to give you this form by 1/31 (if your apartment/house has more than one rented unit) or a reasonable amount of time after you ask for it (if there's only one unit).
Use these forms from the Vermont Department of Taxes to claim the renter rebate.  
Links to all Vermont tax forms and their instructions.