Skip to main content

Log in links for this page

CORI Forms

Forms and policies for organizations and individuals making CORI requests can be found here.
Skip table of contents

Table of Contents

You skipped the table of contents section.

Acknowledgement Forms

CRA Acknowledgement Form 

To be used by organizations using consumer reporting agencies to conduct CORI checks for employment, volunteer, subcontractor, licensing, and housing purposes.

CRA Acknowledgement Form Abbreviated 

To be used by organizations using consumer reporting agencies to conduct CORI checks for employment, volunteer, subcontractor, licensing, and housing purposes. This is an abbreviated version.

Housing Acknowledgement Form 

This language may be included in an organization’s application for the purpose of obtaining authorization for a CORI for the purpose of screening applicants for the rental or lease of housing.

Housing Acknowledgement Form Abbreviated 

This language may be included in an organization’s application for the purpose of obtaining authorization for a CORI for the purpose of screening applicants for the rental or lease of housing. This is an abbreviated version.

Licensing and Employment Acknowledgement Form 

To be used by organizations conducting CORI checks for employment or licensing purposes.

Licensing and Employment Acknowledgement Form Abbreviated 

To be used by organizations conducting CORI checks for employment or licensing purposes. This is an abbreviated version.

Model Adverse Action Notification Letter 

A Model Letter that organizations may use to notify an applicant of a potential adverse decision.

Forms for Organizations

Fee Waiver Request Form 

Organizations who believe they may qualify for a fee waiver must complete and submit this form.

Personal Request Forms

Personal Request Form 

Use this form to request a copy of your own CORI.

Affidavit of Indigency 

If you believe you may qualify for a waiver of the CORI request fee complete this form and submit with your completed Personal Request Form

Other Request Forms

Advocate or Designated Representative Request Form 

An advocate and/or designated representative may submit this form for the purpose of requesting CORI on behalf of a client.

Child Care Provider Request Form 

This form may be submitted by parents or legal guardians of minor children (aged 17 and under) that seek to screen prospective child care providers.

Home Health Aide Request Form 

This form may be submitted by an elderly or disabled person who seeks to screen a prospective home health aide.

Attorney Request Form 

An attorney may submit this form for the purpose of requesting CORI on behalf of a client.

Open Access Request Form 

This form is only to be used to request CORI under the Open Access provisions of M.G.L. c. 6, §172.

Deceased Individual Request Form 

This form may be submitted by anyone seeking to obtain CORI information on a deceased individual. Request must include proof of death.

Help Us Improve Mass.gov  with your feedback

Please do not include personal or contact information.
Feedback