Housing Discrimination Complaint Form

2. Federal law prohibits housing discrimination based on your race, color, national origin, religion, sex, family status, or disability. If you have been trying to buy or rent a home or apartment and you believe your rights have been violated, you can file a fair housing complaint.

4. You can file a complaint right now, by using this online form, or you can call us at 336-651-7582.

6. Full Name*

8. Address*

10. City*

11. Zip Code*

13. Daytime Phone*

14. Evening Phone

16. Email*

20. What happened to you? How were you discriminated against?*

    For example: were you refused an opportunity to rent or buy housing? Denied a loan? Told that housing was not available when in fact it was? Treated differently from others seeking housing? State briefly what happened.

22. Why do you believe you are being discriminated against?*

    It is a violation of the law to deny you your housing rights for any of the following factors: race, color, religion, sex, national origin, familial status (families with children under 18), disability. For example: were you denied housing because of your race? Were you denied a mortgage loan because of your religion? Or turned down for an apartment because you have children? Were you harassed because you assisted someone in obtaining their fair housing rights? Briefly explain why you think your housing rights were denied because of any the factors listed above.

24. Who do you believe discriminated against you? *

    Was it a landlord, owner, bank, real estate agent, broker, company, or organization? Please include name and address if available.

28. Where did the alleged act of discrimination occur?

30. Street Address*

32. City*

33. Zip Code*

35. When did the last act of discrimination occur?*
    When did the last act of discrimination occur?

36. Is the alleged discrimination continuous or on going?*

    1. No
    2. Yes

Leave This Blank:


38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit

* indicates a required field