Anti-Discrimination Center

Are you seeking assistance because you believe you have been the victim of housing discrimination? We wish we were set up to handle telephone inquiries, but we’re not, so we need to ask you to contact us by using this form.

Your Name: *

Your Email: *

Daytime Telephone Number: *

Evening Telephone Number: *

Address of Property Where the Discrimination Occurred:

Names of People/Entities Who Discriminated Against You:

When Discrimination Occurred:

Basis of Housing Discrimination (Check as many as apply):

Race

Color

National Origin

Sex

Religion

Disability

Familial Status (having children)

Additional Protections available in some States and Localities (Check as many as apply):

Age

Sexual Orientation

Domestic Partner Status

Marital Status

Source of Income

Alienage or Citizenship Status

Survivor of Domestic Violence

Law Occupation Status

What Happened?: *

IMPORTANT: Read the fine print below!!!: By submitting this form, you are seeking a legal consultation in New York (where the Anti-Discrmination Center is headquartered), and acknowledging that this form is not intended to suggest, and should not be interpreted as suggesting, that any legal services would ever be provided outside of New York. In addition, this form is not intended to suggest, and should not be interpreted as suggesting, any agreement on the part of the Anti-Discrimination Center or anyone associated with the Anti-Discrimination Center to provide representation to any person either in New York or outside of New York. Because we do not know if we can help you, and because we cannot be sure when we will be able to respond to you (though we try to do so quickly), it is important that you do not delay taking any action to preserve your rights. More generally, you should not act or fail to act in reliance on anything you believe that the Anti-Discrimination Center or anyone associated with the Anti-Discrimination Center may do.

Agreement: *

I have read and agree to the above.