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
Format: (000) 000-0000.
Multi line input
Please briefly describe the housing discrimination you experienced.
Briefly describe the housing discrimination you experienced.
Characters used: 0 out of 1500.
RaceColorReligionNational OriginSex (includes Pregnancy and Sexual Harassment)Familial StatusDisabilitySexual Orientation, Gender Identity, or ExpressionSource of IncomeMilitary Status/HistoryOther
* 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)
YesNo
YesNo
Should be Empty: