FHF Racial Discrimination Form

FHF Racial Discrimination Form

Report Discrimination Contact Information
Name
First Name
Last Name Email
example@example.com
Address
Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Phone
Multi line input
Please briefly describe the housing discrimination you experienced.
Briefly describe the housing discrimination you experienced.
Characters used: 0 out of 1500.
On which of the following do you believe the discrimination was based?

Race Color Religion National Origin Sex (includes Pregnancy and Sexual Harassment) Familial Status Disability Sexual Orientation, Gender Identity, or Expression Source of Income Military Status/History Other
* 11. Who discriminated against you? If not applicable, indicate "N/A"; if unknown, indicate "unknown."
Company/Organization name(s)
Individual name(s)
12. Most recent act of discrimination (Month/Year)
Have you contacted other organizations, including attorneys, about this matter?

Yes No
14. Has a fair housing administrative complaint or lawsuit ever been filed in this matter?

Yes No
Should be Empty:

Now create your own JotForm - It's free! Create your own JotForm