Request Help In Another Language

HOME is a private, non-profit civil rights organization. Providing information to HOME does not create an attorney-client relationship between you and HOME. However, we will review your submission and will follow-up to conduct a telephone intake to see how we may assist you or determine the appropriate resources to refer you. If HOME agrees to provide you with assistance, the terms and conditions of any assistance or legal representation will be discussed with you and set forth in writing. At any time, you may also file an official Fair Housing Complaint with the Virginia Fair Housing Office or HUD’s Fair Housing Office

Report Housing Discrimination

Sharing your story with HOME can help someone else avoid what you have experienced and help HOME understand where and how discrimination manifests throughout Virginia. We will not share any of your personal information without your permission. By sharing your story with us, you will help us help you or others who may share your experience.

Please explain the housing discrimination experienced:(Required)

Describe in detail what happened

What is the date of the most recent housing discrimination experience?

Why do you believe discrimination occurred?(Required)

Select all that apply

Why discrimination occurred – Other:

Where did the alleged housing discrimination take place?(Required)

Include address of property, name of property, city and zip code

Who committed the alleged housing discrimination?

List Company(s), Organization(s), and/or individuals

In which housing sector did the alleged discrimination take place?(Required)

Select all that apply

Rental

Real Estate

Lending

Insurance

Appraisal

Other

Housing Sector – Other

Who are you reporting discrimination on the behalf of:(Required)

Self/Household

Other Family Member

Client

Other

Does anyone involved have evidence of the alleged housing discrimination?(Required)

Examples of evidence are text messages, emails, photos, documents, videos, etc.

Yes

Steps Taken

This information will help us understand the role HOME can take on when assisting you

What is your goal in reaching out to HOME?(Required)

Select all that apply

To understand my Fair Housing Rights

Learn how to file an official Fair Housing Complaint (with HUD or VFHO)

Anonymously inform

Other

Goal – Other:

Have you filed a Fair Housing Complaint with the Virginia Fair Housing Office, HUD, or filed a fair housing lawsuit about this matter?(Required)

Virginia Fair Housing Office: www.dpor.virginia.gov/FairHousing
HUD’s Fair Housing Office: www.hud.gov/program_offices/fair_housing_equal_opp/online-complaint

Yes

Is anyone involved in immediate risk of being evicted or experiencing homelessness because of the alleged housing discrimination?(Required)

Yes

Have you spoken with another organization, agency, or attorney about this matter?(Required)

Yes

If so, whom?

Enter the name(s) of other agencies you’ve spoken with

Your Contact Information

This information will help us understand the role HOME can take on when assisting you

Do you want HOME to contact you about this matter?(Required)

Yes

No, I just wanted to anonymously inform

Your Contact Info

Name(Required)

First Last

Preferred Pronouns

Phone(Required)

Country Phone Number

Email(Required)

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Demographic Information

HOME receives federally funded grants and often our funders ask for demographic information to ensure our services are being provided in an inclusive manner. This information also helps to better understand the communities we are serving and to identify any fair housing trends experienced by specific communities. To make the most of your intake meeting, filling out this information now will allow you and the fair housing staff to be solely focused on the allegation of discrimination. Your answers should be based on the person who experienced the housing discrimination.

Do you refuse to provide demographic information?

Yes, I understand this limits what assistance I may receive

No, I will provide the information

Demographic Info

Race

Does the victim identify as Hispanic/Latino?

Yes

National Origin

Gender

Are there children under the age of 18 in the household?

Yes

Is there a person in the household with a disability?

Yes

What is your marital status?

Estimated Monthly Household Income* (compare)

How did you hear about HOME of VA?

Referral – Other

Please enter the name of the event you attended or the agency that referred you to HOME of VA