Follow the steps to effectively complete the questionnaire online.

1. Click ‘Get Form’ button to access the questionnaire and view it in the online editor.
2. Start by filling out your personal information, which includes your name, date of birth, gender, address, and racial identity. Ensure all information is entered clearly.
3. Provide your daytime and evening telephone numbers, along with a contact person who can reach you if needed. Include their telephone number as well.
4. Next, fill in details about the housing provider that you believe discriminated against you. Enter the name, address, city, state, and telephone number of the provider.
5. Indicate the address of the property involved in your claim. Include the property name, address, city, state, and postal code.
6. Respond to questions regarding your residence at the specified address and whether you experienced discrimination there.
7. Select the basis for your discrimination claim from the provided options and fill in additional required fields for each basis you select.
8. In the section for your discrimination claim, provide a brief yet comprehensive statement explaining the nature of the discrimination you experienced.
9. Include details of any prior attempts to resolve the issue, including mediation efforts and any assistance from other agencies.
10. Finally, sign and date the questionnaire, confirming that your statements are true and accurate. After reviewing, you can save changes, download, print, or share the completed form as needed.

Complete your questionnaire online today to take the next step in addressing housing discrimination.