HUD Form903 Complaint

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:
*Zip Code:

Daytime Phone No:
Evening Phone No:
Best Time to Call:

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:
Daytime Phone No:
Evening Phone No:
Best Time to Call:

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:
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