Report Discrimination - NFHA (original) (raw)

Report housing Discrimination

Preliminary Intake Form

View in Spanish

Submit this form to NFHA if there is no fair housing center in your area. We will review your submission and follow up to conduct an intake to see how we may be able to assist or refer you to appropriate resources. If there is a local fair housing center in your area, NFHA may refer you and this information to them. You can also file a complaint directly with HUD.

• Name
  First Last
• Preferred Pronouns (optional)
• Please identify your race (Select all that apply)*
  • Asian
  • American Indian or Alaskan Native
  • Native Hawaiian or Other Pacific Islander
  • White
  • Hispanic or Latino
  • Black or African American
  • Other
• Race – Other*
• Email Address*
  Enter Email Confirm Email
• Phone Number*
• City*
• State*
• Zip Code*
• What Happened?*
• Does this complaint involve appraisal discrimination?*
  • Yes
  • No
• Are you a reporting information about your employer or your former employer?*
  • Yes
  • No
• 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
• Explain

• Who Discriminated Against You?

• Company/Organization Name(s)
• Individual Name(s)
• Most recent act of discrimination (Month/Year)
• Have you contacted other organizations, including attorneys, about this matter?*
  • Yes
  • No
• Please name the organizations, or attorneys, that you’ve contacted about this matter.
• Has a fair housing administrative complaint or lawsuit ever been filed in this matter?*
  • Yes
  • No

• Tell us about your administrative complaint or lawsuit:

• Venue (i.e. federal court, state court, HUD, or name of state/local government agency)*
• Month/Year filed*
• Status (i.e. pending, settled, dismissed, withdrawn, etc.)*