Constituent Services Request

If you would like to request assistance with a Federal Agency, please fill out and submit the form below. While we cannot guarantee a favorable outcome, we will do our best to help you receive a response from the Agency handling your case. Please complete as many of the fields in the form below as possible. The required fields are noted. A member of my staff will follow up with you. If you have any questions or if this case is urgent, please feel free to call my Vermont District Office at (802) 652-2450.

Required fields are followed by *

Contact Information

First Name: *

Middle Name:

Last Name: *

Street Address: *

Street Address: (Continued)

City: *

State: *

Zip Code: *

Email Address: *

Phone: *

Date of Birth:

Case Information

Federal Agency/Office Where Case is Pending:

Type of Case:

Case/ID #:

Case Filing Date:

Have you contacted another Congressional office?: * Yes No

Which office:

Briefly describe the issue(s) & relief requested (include current status of case): *