Impediments to Fair Housing Choice - English
English
1. I currently reside in: (Select one)
Ceres
Modesto
Hughson
Newman
Oakdale
Patterson
Riverbank
Turlock
Waterford
Other
Enter Zip Code
*
2. I consider my race to be: (Select all that apply)
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
3. I consider my ethnicity to be (Select one)
Hispanic/Latino
Non-Hispanic/Non-Latino
4. What is your Gender
Male
Female
Non-Binary
Non-Conforming (Not exclusively Male or Female)
Trans Female (Male to Female)
Trans Male (Female to Male)
Prefer not to Answer
Other, please specify below
Other
5. Which of the following best describes your living situation? (select one)
Single-Family home
Condo/Townhouse
Apartment building (2-4 units)
Apartment building (5+ units)
Homeless
Mobile Home
Guesthouse (no kitchen)
Renting a room
Other, please specify below
Other
6. Do you currently rent your home, own your home, or something else?
Rent from a Housing Authority
Rent from a private landlord
Own
Homeless
Other
7. Do you receive housing assistance of any kind?
Yes
No
8. What type of housing assistance do you currently receive?
None
Section 8
Shelter Plus Care Voucher
Hotel/Motel Voucher
Other
9. If using a voucher, how difficult was it for you to find a landlord willing to accept your voucher?
Very Difficult
Difficult
Easy
Very Easy
10. Have you been displaced from your home in the last 5 years?If you answered No, please skip to Question #14.
Yes
No
11. Within the last 5 years, have you been displacedfrom your home for any of the following reasons?
Foreclosed
Purchased by new owners
Renovated/improved
Unaffordable rent increase
Evicted
Natural Disaster
Chose to move
No
Other
12. Do you spend more than half of your take home pay on housing (rent or mortgage)?
Yes
No
13. If you had a choice, would you continue to live in your neighborhood?
Yes
No
Unsure
14. If No, indicate why: (Safety, lack of transportation, affordability, schools, etc.)
15. In looking for housing do you believe you were ever discriminated against?
Yes
No
Unsure
If you answered Yes, on what basis do you think you were discriminated against?
Race
Sex
National Origin
Familial Status (Presence of Children)
Color
Martial Status
Disability
Sexual Orientation
Gender Identification/Gender Expression
Martial Status
Medical Condition
Ancestry
Source of Income
Age
Arbitrary Discrimination
Other
16. Did you report the discrimination?
Yes
No
Other
17. If No, why?
Do not know where to report
Afraid of retaliation
Too much trouble
Do not believe it would make a difference
Other
18. Are you aware of the Fair Housing requirements which prohibit discrimination in buying, selling, renting, or lending based on race,religion, color, national origin, sex, family status, or disability?
Yes
No
19. If you encountered housing discrimination,do you know how to report it?
Yes
No
If Yes, how would you report it?
20. Do you believe you have ever been denied a mortgage on the basis of race,religion, color, national origin, sex, family status, or disability?
Yes
No
Never applied for a mortgage
Other
21.Do you believe you have been a victim of predatory lending (Example: unfair,deceptive, or fraudulent practices of some lenders during the loan originationprocess often resulting in unfair or abusive loan terms)?
Yes
No
If yes, why?
22. Do you or a member of your household have a disability of any typesuch as physical, mental, or developmental?
Yes
No
23.Do you have any other comments about barriers, disability services, or accessto fair housing?
Submit
Should be Empty: