Housing Discrimination Form

Please fill out this form which will be reviewed by the Fair Housing Program staff.  We will contact you by phone as soon as possible.  Items marked with an * are required.

Please print out a copy of this form for your files.


Complaint Against

Property Involved in Complaint

The address of the property is:

Details of Act


By submitting this information, I declare the above information and statements are true and correct to the best of my knowledge and belief. I will sign a copy of this submitted information when I meet with a Fair Housing Representative.