File a Housing Discrimination Complaint

Human Rights and Equity Programs Alert:

First Name:

Last Name:

Address:

City:

State:

Zip:

Home Phone:

Mobile Phone:

Work Phone:

E-Mail Address:

Best time to contact you:

Who else can we contact if we cannot reach you?

Contact's Name:

Contact's Phone:

Relationship to You:

Who else has been harmed in the same way you were?

If the person discriminated against is age 18 or older, we will need that person's signature before we can proceed with this complaint. Under the Fairfax County Human Rights Ordinance only the person harmed or their legal guardian can file with the Human Rights Commission.

How were you discriminated against? For example: Were you refused and opportunity to rent or buy housing? Denied a loan? Told that housing was not available in fact it was? Treated differently from other seeking housing?

Briefly state what happened:

Date of Birth

Briefly explain why you think your housing rights were denied:

Indentify all parties who you believe discriminated against you:

1. Name:

Address:

2. Name:

Address:

3. Name:

Address:

4. Name:

Address:

Address

County:

City

State

ZIP/Postal Code

Date the discrimination occurred

Is the alleged discrimination continuing or ongoing?

Yes

In Fairfax County is Unlawful to Dicriminate in Housing Based on These Factors...

Race
Color
National Origin
Religion
Sex
Familial Status (families with children under the age of 18, or who are expecting a child)
Handicap (if you or someone close to you has a disability)
Elderliness (age 55 or older)
Marital Status

If You Believe Your Rights Have Been Violated...

The Fairfax County Human Rights Commission is ready to help you file a complaint.
After your information is received, the Fairfax County Human Rights Specialist will contact you to discuss the concerns you have raised.

Human Rights and Equity Programs

Human Rights and Equity Programs Alert:

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