Intake Form

Intake Form 2021-01-04T18:02:49+00:00
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Intake Form


  • 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

  • Questionnaire

  • Who do you believe discriminated against you?

  • Where did the alleged discrimination occur?

  • When did the alleged discrimination occur?

  • Other Contact Details