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FAIR HOUSING MONTH 2021

Report Housing Discrimination
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Submit Insurance Documents

Tester Name (required)

Please upload employment documents. (required)

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Become a Tester

Testing is a vital part of the Fair Housing Law Center. Testing is one of the ways we measure if discrimination is occurring in our community. If you are interested in being a paid volunteer, please complete the application below.

Fair Housing Law Center Tester Application

Contact Information

Name(required)

Address(required)

City(required)

State(required)

Zip Code(required)

Phone (Cell or Home)(required)

Email Address(required)

Date of Birth(required)

Month Day Year

Education

High School

Address

Did You Graduate from High School?

Yes

No

Year Graduated

Grade Completed

Did You Attend a College or University?

Yes

No

College/University

Major

Did You Graduate?

Yes

No

Degree Earned

Year Graduated

Do You Have Any Post-Graduate Education?

Yes

No

College/University

Major

Did You Graduate?

Yes

No

Degree Earned

Year Graduated

Employment

Are You Currently Employed?

Yes

No

Employer

Address

Occupation

Length of Employment

Will You Be Able to Conduct a Test During Working Hours?

Yes

No

Prior Employment

What other types of work have you performed in the last 5 years? Provide name and address of employer, length of employment, and position.

Background Information

Do You Have Access to a Vehicle?(required)

Yes

No

Make and Model

Year

In What Area(s) Will You be Available to Work?

Armstrong

Bedford

Beaver

Blair

Butler

Cambria

Centre

Clarion

Clearfield

Crawford

Erie

Fayette

Forest

Greene

Huntingdon

Indiana

Jefferson

Lawrence

Mercer

Somerset

Venango

Warren

Washington

Westmoreland

Brooke (WV)

Hancock (WV)

Marshall (WV)

Ohio (WV)

Please check all counties

Have You Ever Been Convicted of a Felony?(required)

Yes

No

Please Provide Date, Location, and Description

Have You Been or are You Currently a Real Estate Agent, Landlord, Mortgage Lender, or Insurance Agent?(required)

Yes

No

Please Provide More Information

Do You Have a Family Member Who Has Been or is Currently a Real Estate Agent, Landlord, Mortgage Lender, or Insurance Agent?(required)

Yes

No

Please Provide More Information

Availability

Please specify the hours when you are most available for work.

Monday

Thursday

Tuesday

Friday

Wednesday

Saturday

Why Do You Want to be a Fair Housing Tester?

Signature(required)

Please type your full name.

Date(required)

Please type today's date (MM/DD/YYYY)

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Education & Outreach

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What Is Fair Housing?

Reasonable Accommodations & Modifications

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Fair Housing Month 2021

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