1. Why were you discriminated against?
(Example: Refused opportunity to rent or buy a house, a loan, etc..)
2. Why do you think you are a victim of housing discrimination?
(Example: Is is because of your race, color, religion, sex, religion, family status (families with children under 18), disability?)
3. Who do you believe discriminated against you?
(Example: Landlord, owner, bank, real estate agent/broker, company or organization)
4. Where did the alleged act of discrimination occur?
(Example: A rental unit, single family home, public or assisted housing, a mobile home, a bank or other financial institution (note each one). State briefly what happened below.)