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Human Relations Commission Intake Questionnaire - Housing

  1. Please answer the following questions, briefly explaining why you feel you have been discriminated against in housing within the city of Elgin.

  2. If other than Elgin, please enter city.

  3. If other than IL, please enter state.

  4. Actions by the above person(s) about which you are complaining:*

  5. Which of the following factors were involved in the above action:*

  6. Is a federal or state subsidy involved?*

  7. Does the owner live on the premises?*

  8. Thank you for submitting the form. We will contact you within a week.

  9. If you wish to receive an email copy of this form instead of printing, please check the box below and enter your email address.

  10. Leave This Blank:

  11. This field is not part of the form submission.