Fair Housing Program: Complaint Form
If you believe you have experienced illegal housing discrimination, please fill out and submit the following form.
First Name: *
Your answer
Last Name: *
Your answer
Address: *
Your answer
City: *
Your answer
Zip Code: *
Your answer
Email: *
Your answer
Phone: *
Your answer
Alternate Phone:
Your answer
Why do you believe you were discriminated against? Please check all that apply. *
Required
Please briefly describe what happened in the space below: *
Your answer
Who do you believe discriminated against you?
Name:
Your answer
Title or Position:
Your answer
Address:
Your answer
City:
Your answer
Zip Code:
Your answer
Phone Number:
Your answer
Email:
Your answer
When did the discrimination occur?
MM
/
DD
/
YYYY
Is it still happening?
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