Housing Inquiry Form | Fair Housing Action Center of Maryland

Name

Street Address of the property you're contacting us about *

City and State *

Zip Code *

Email address (If you don't have access to email, please provide a phone number.)

Race *

Your Gender *

Female

Male

Transgender

Other

Your age *

Your total combined yearly household income, in whole dollars. Please include income for all family members/people living in your home. *

Number of adults living in the home *

Number of children living in the home *

Do you receive a housing subsidy? (Tenants Only) *

Yes

No

If you receive a housing subsidy, please list the type of subsidy and the name of the agency that issued/manages your subsidy. (Tenants only)

Do you have a disability? *

Yes

No

Your Housing Issue (Please be as detailed as possible.)

Where did you hear about the Fair Housing Action Center of Maryland?

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