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Examples of Housing Discrimination
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FAIR HOUSING MONTH 2021
Report Housing Discrimination
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Assessment
Have you been discriminated against in your housing because of your sexual orientation or gender identity?
(required)
Yes
No
Have you ever been sexually harassed by your landlord, including offers for free rent for sex or threats if you don’t comply with sexual demands?
(required)
Yes
No
What is your race?
(required)
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or other Pacific Islander
White
Other
Have you ever been denied housing or threatened with eviction because of your race or the race of someone associated with you?
(required)
Yes
No
Has any housing provider made discriminatory statements about your race or the race of someone associated with you?
(required)
Yes
No
Have you ever been charged more rent or offered different mortgage terms because of your race?
(required)
Yes
No
What is your nationality?
(required)
Please type in the box above.
Have you ever been denied housing or threatened with eviction because of your nationality or the nationality of someone associated with you?
(required)
Yes
No
Has any housing provider made discriminatory statements about your nationality or the nationality of someone associated with you?
(required)
Yes
No
Have you ever been charged more rent or offered different mortgage terms because of your nationality?
(required)
Yes
No
What is your gender?
(required)
Male
Female
Other
Have you ever been denied or threatened with eviction because of your gender?
(required)
Yes
No
Has any housing provider made discriminatory statements to you about your gender?
(required)
Yes
No
Have you been evicted or denied housing because you’re a victim of domestic violence?
(required)
Yes
No
Do you have a religion that is known or obvious to your housing provider?
(required)
Yes
No
What is your religion?
(required)
Has a housing provider denied you housing or evicted you based on your religion?
(required)
Yes
No
Has a housing provider evicted you based on your religion?
(required)
Yes
No
Has a housing provider made discriminatory statements about your religion?
(required)
Yes
No
Do you have children that live with you?
(required)
Yes
No
How many children live with you?
(required)
1
2
3
4
5
6+
Have you ever been denied housing or threatened with eviction because you have children?
(required)
Yes
No
Have you ever been told that you have too many children for a particular unit?
(required)
Yes
No
Have your children been denied access or limited access to certain areas of the property, such as swimming pools?
(required)
Yes
No
Have you ever been charged more rent or utilities because you have children?
(required)
Yes
No
Have rental ads that say “no children” or “not suitable for children” discouraged you from calling about a unit?
(required)
Yes
No
Do you or someone in your household have a disability?
(required)
Yes
No
Do you need any modifications to your housing to make it more accessible?
(required)
Yes
No
Do you need any accommodations to your housing provider’s rules or policies?
(required)
Yes
No
Has any housing provider made discriminatory statements about your disability or the disability of someone in your household?
(required)
Yes
No
Have you been or are you being charged extra for an assistance animal?
(required)
Yes
No
Have you experienced any other housing discrimination?
(required)
Yes
No
Please explain
(required)
May we contact you?
(required)
Yes
No
First Name
Last Name
Email address
Phone
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