Follow the steps to fill out your Housing Discrimination Complaint Questionnaire.

1. Click ‘Get Form’ button to access the Housing Discrimination Complaint Questionnaire and open it in the editor.
2. Begin by entering your personal information. Provide your full name, date of birth, gender, and racial identity. This information is essential for identification purposes.
3. Fill in your residential address, including the city, county, state, and zip code. Ensure that this information is current and accurate.
4. Next, provide your daytime and evening telephone numbers, along with an alternative contact's name and phone number who can reach you.
5. Include your email address, noting that it may be considered a public record under Florida law. Make sure to provide it only if you are comfortable with its potential disclosure.
6. Indicate how you learned about the Palm Beach County Office of Equal Opportunity. Filling this out helps track outreach effectiveness.
7. Provide detailed information about the housing provider involved in your discrimination claim, including their name, address, and contact number.
8. Describe the property associated with your claim, and specify whether you were residing there at the time of the alleged discrimination.
9. Select the basis for your discrimination claim from the listed options, and provide any required additional details relevant to your specific situation.
10. Briefly outline the specific action you believe was discriminatory, including any harm it caused you or others. Use clear, concise language, and continue on additional sheets if necessary.
11. Indicate any responses from the housing provider regarding your allegations, and state your reasons for believing the treatment was discriminatory.
12. Identify witnesses or others who have knowledge of your claim, including their contact details and what they may contribute.
13. Finally, declare your understanding of the process and your truthfulness under penalty of perjury by signing and dating the form.
14. Once completed, you can choose to save your changes, download a copy, print, or share the form as needed.

Complete your Housing Discrimination Complaint Questionnaire online today to ensure your concerns are addressed promptly.