Housing Discrimination: Share Your Story
We will never share your personal information or without your permission.
I am/was a... *
Required
What type of discrimination? *
Required
Tell us what happened: *
please include details about the neighborhood, development, etc
Your answer
In what city did this happen? *
Your answer
In what state did this happen? *
Your answer
When did this happen? *
year(s)
Your answer
Did you file a complaint? *
If not, why not?
Your answer
If yes, to what agency?
Were you satisfied with how your case was handled?
Your answer
Your name *
First name, last name
Your answer
How can we contact you? *
Please include phone number or email
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.