NFHA Housing Discrimination Referral Form Name *FirstLastEmail *Phone Number *City *State *Alternate contact information:Synopsis of allegations: *On which protected characteristic(s) was the discrimination based: *RaceColorReligionNational OriginSex (including pregnancy)Familial StatusDisabilitySexual OrientationGender Identity or ExpressionSource of IncomeMilitary status/historyOther (explain):Date of most recent incident of alleged discrimination. *Which organizations have you contacted about this matter? :Are you working with an advocate or attorney on this matter? : *Has a fair housing complaint or lawsuit ever been filed in the matter? : *NameSubmit
