Your housing discrimination complaint will be reviewed by a fair housing specialist to determine if it alleges acts that might violate the Fair Housing Act. The specialist will contact you for any additional information needed to complete this review. If your complaint involves a possible violation of the Fair Housing Act, the specialist will assist you in filing an official housing discrimination complaint.

Enter your personal information.

*First Name:

*Last Name:

Email:

*Your Address:

*City:

*State:

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*Zip Code:

Daytime Phone No:

Evening Phone No:

Best Time to Call:

Day Evening

Who else can we call if we cannot reach you?

*1. Contact's First Name:

*Last Name:

Organization:

2. Contact's First Name:

Last Name:

Organization:

*Daytime Phone No:

Evening Phone No:

Best Time to Call:

Day Evening

Daytime Phone No:

Evening Phone No:

Best Time to Call:

Day Evening

Enter complaint information.

*1. What happened to you? How were you discriminated against? For example: were you refused an opportunity to rent or buy housing? Denied a loan? Told that housing was not available when in fact it was? Treated differently from others seeking housing? State briefly what happened. (4000 character limit)



2. Why do you believe you are being discriminated against? It is a violation of the law to deny you your housing rights for any of the following factors: - race - color - religion - sex - national origin - familial status (families with children under 18) - disability.

For example: were you denied housing because of your race? Were you denied a mortgage loan because of your religion? Or turned down for an apartment because you have children? Were you harassed because you assisted someone in obtaining their fair housing rights? Briefly explain why you think your housing rights were denied because of any the factors listed above. (4000 character limit)

3. Who do you believe discriminated against you? Was it a landlord, owner, bank, real estate agent, broker, company, or organization?

First Name:

Last Name:

Organization:

Address:

4. Where did the alleged act of discrimination occur? Provide the address. For example: Was it at a rental unit? Single family home? Public or Assisted Housing? A Mobile Home? did it occur at a bank or other lending institution?

Address:

City:

*State:

Select State - Not in the U.S. Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware Dist. Of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Micronesia Minnesota Mississippi Missouri Montana N. Mariana Islands Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming

Zip:

*5. When did the last act of discrimination occur? Enter the date (mm/dd/yyyy):

Is the alleged discrimination continuous or on going?

Yes No