Skip to content
Toggle Navigation
Home
About
Who We Are
Staff & Board
Annual Reports
Career Opportunities
News
Events
Get Help
Membership
Contact
Our Impact
Our 2024 Impact by County and Legislative District
Our 2023 Impact by County and Legislative District
Donate
Cy Pres Funding
Topics
Toggle Navigation
Older Adults
Tenant Advocacy
Fair Housing
Policy Advocacy
Digital Equity
Medical Debt
Fair Housing Complaint Intake Form
Carol Ott
2025-06-06T09:45:18-04:00
Fair Housing Complaint Intake Form
"
*
" indicates required fields
Facebook
This field is for validation purposes and should be left unchanged.
I am a…
*
Tenant
Home Buyer
Mortgage Customer
Neither: I am filling this out on behalf of a client
Your First and Last Name
*
Your Race
*
American Indian or Alaska Native
Asian
Black or African-American
Native Hawaiian or Pacific Islander
White
Are you Hispanic or Latino/Latina?
*
Yes
No
Client's Race
*
American Indian or Alaska Native
Asian
Black or African-American
Native Hawaiian or Pacific Islander
White
Is client Hispanic or Latino/Latina?
*
Yes
No
Your Gender
*
Female
Male
Transgender
Non-Binary/Other Gender
Client's Gender
*
Female
Male
Transgender
Non-Binary/Other Gender
Your Age
*
Client's Age
*
Your Yearly Household Income (including all adults who reside with you)
*
Client's Yearly Household Income (including all adults who reside in the home)
*
Monthly Housing Payment (Rent or Mortgage)
*
Number of Adults Living in the Home
*
Number of Children Living in the Home
*
Do you receive a housing subsidy? If yes, indicate which type (HCV, LIHTC property, etc.)
*
Does client receive a housing subsidy? If yes, indicate which type (HCV, LIHTC property, etc.)
*
Do you have a disability?
*
Yes
No
Does client have a disability?
*
Yes
No
Your Email Address
*
Your Phone Number
Preferred Method of Contact
*
Email
Phone
No Preference
Client's Email Address
*
Client's Phone Number
Type of Fair Housing Complaint
*
Race
Gender Identity
Familial Status
Source of Income
National Origin
Sexual Orientation
Disability (Including Emotional Support and Service Animals)
Street Address of the Property You're Contacting Us About
*
Street Address
Address Line 2
City
ZIP Code
County or City
*
Allegany
Anne Arundel
Baltimore City
Baltimore County
Calvert County
Caroline County
Carroll County
Cecil County
Dorchester County
Frederick County
Garrett County
Harford County
Howard County
Kent County
Montgomery County
Prince George's County
Queen Anne's County
Somerset County
St. Mary's County
Talbot County
Washington County
Wicomico County
Worcester County
Name of Landlord/Management Company, Realtor, or Mortgage Company
*
Please describe your Fair Housing issue here. Please be as detailed as possible. (5000 character maximum)
*
Please re-type your first and last name here. You affirm and certify that all the information and answers to questions herein are complete, true and correct to the best of your knowledge and belief. If you are filling this out on behalf of someone else, you would need to include your own name.
*
Which organizations have you contacted about this issue before contacting us?
*
How did you hear about us?
*
Δ
Page load link
Go to Top
