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2. Your housing discrimination complaint will be reviewed by the City of Shaker Heights Fair Housing Office to determine if it alleges acts that might violate local, state and/or federal fair housing laws. City staff will contact you for any additional information needed to complete this review. If your complaint involves a possible violation of the Fair Housing Act, staff will assist you in filing an official housing discrimination complaint.
4. Your Name*
5. Email
7. Address*
9. City*
10. State*
11. Zip Code*
13. Daytime Phone Number
14. Cell Phone Number
16. WHO CAN WE CALL IF WE CANNOT REACH YOU?
18. Contact's First Name
19. Last Name
21. Organization (If Applicable)
22. Best Daytime Phone Number*
24. COMPLAINT INFORMATION
26. 1. What happened to you? How were you discriminated against?*
    For example: were you refused an opportunity to rent or buy housing? Denied a loan? Told that housing was not available when in fact it was? Treated differently from others seeking housing? Refused a requested accommodation or modification?
28. 2. Why do you believe you are being discriminated against? What was the basis that your fair housing rights were violated? In Shaker Heights, it is a violation of the law to deny you your housing rights for any of the following factors: race - color - religion - sex - national origin/ancestry - familial status (families with children under 18) - disability - sexual orientation - gender identity or expression - military status.
    For example: were you denied housing because of your race? Were you refused an apartment because you have children? Were you denied an accommodation because of a mental or physical disability? Were you harassed because you assisted someone in obtaining their fair housing rights?
30. 3. Who do you believe discriminated against you? Was it a landlord, owner, bank, real estate agent, broker, company, or organization?
32. First Name
33. Last Name
35. Company/Organization
37. Address
38. Phone
40. City
41. State
42. Zip
44. 4. Where did the alleged act of discrimination occur? Provide the address. For example: Was it at a rental unit? Single family home? Apartment or condominium? A bank or other lending institution?
46. Address
47. Building/Institution (If Applicable)
    Provide name of apartment/condominium complex, bank or lending institution or other organization if applicable.
49. City
50. State
51. Zip
53. Phone
54. Was the property involved a:

    1. Single-family house
    2. 2-4 unit house
    3. Apartment building with 5 or more rental units

    1. Condominium building
    2. Senior housing
56. 5. When did the last act of discrimination occur?*
    5. When did the last act of discrimination occur?
57. Is the discrimination ongoing?*

    1. Yes

    1. No
Leave This Blank:


59. 1. Receive an email copy of this form.
60. Email address

    This field is not part of the form submission.

61. Submit

* indicates a required field