Intake Form for Housing Discrimination Complaints
This intake form allows individuals to file complaints regarding housing discrimination. The form must be completed and submitted to initiate an interview with a Civil Rights Department representative. Fill out the required information to ensure your complaint is acknowledged.
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How do I fill this out?
To fill out this form, begin by providing your personal information in the designated sections. Ensure that all required fields are accurately filled to avoid delays. Confirm that you understand the purpose of the form before submission.

How to fill out the Intake Form for Housing Discrimination Complaints?
1
Gather all necessary personal information.
2
Complete the complainant and respondent sections.
3
Clearly state the allegations and dates of harm.
4
Review the form for any missing information.
5
Submit the completed form via email or mail.
Who needs the Intake Form for Housing Discrimination Complaints?
1
Individuals experiencing housing discrimination.
2
Families with children facing rental issues.
3
People with disabilities needing accommodations in housing.
4
Tenants seeking legal recourse against landlords.
5
Anyone wanting to report harassment in housing situations.
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What are the instructions for submitting this form?
To submit the completed Intake Form, you can email it to contact.center@calcivilrights.ca.gov or mail it to 2218 Kausen Drive, Suite 100, Elk Grove, CA 95758. You may also submit forms through our online system at ccrs.calcivilrights.ca.gov. Ensure all required information and documentation are attached before sending.
What are the important dates for this form in 2024 and 2025?
There are no specific deadlines for this form, but it is advisable to submit as soon as possible for timely assistance. The Civil Rights Department will be operating and accepting forms throughout 2024 and 2025. Regular updates may be provided on their processing times.

What is the purpose of this form?
The purpose of this form is to provide individuals a formal process to report allegations of housing discrimination. By filling out this form, complainants can initiate an investigation into their claims by the Civil Rights Department. It serves as a vital tool for individuals seeking justice and fairness in housing.

Tell me about this form and its components and fields line-by-line.

- 1. Complainant Information: Includes fields for name, contact info, and demographics.
- 2. Respondent Details: Section to input information about the person or business being filed against.
- 3. Allegation Details: Fields for specifying dates and descriptions of discriminatory actions.
- 4. Children's Information: Asks for names and ages of children in the household.
- 5. Interpreter Needs: Option to indicate if language assistance is required.
What happens if I fail to submit this form?
If the form is not submitted, your complaint may remain unaddressed, and you will miss the opportunity to seek resolution. It's important to ensure all fields are completed as required to facilitate the intake process. Incomplete forms could result in delays or rejection of your complaint.
- Incomplete Information: Not providing all required details can hinder the processing of your complaint.
- Missing Documents: Failure to include necessary supporting documents may affect the investigation of claims.
- Deadline Issues: Delays in submission might result in challenges addressing your complaint in a timely manner.
How do I know when to use this form?

- 1. Discrimination Reporting: For formally reporting discrimination based on race, gender, or other protected classes.
- 2. Filing Complaints: To file a complaint against landlords or housing providers.
- 3. Seeking Assistance: For individuals who need resources or assistance related to housing issues.
Frequently Asked Questions
How do I fill out the intake form?
Start by entering your personal details, then proceed to the allegations section and provide clear information.
Can I submit the form online?
Yes, you can submit your completed intake form using our online submission system.
What should I do if I need an interpreter?
Indicate on the form if you require an interpreter and specify the language needed.
Is the intake form confidential?
Yes, your submission is confidential and handled according to the CRD's Privacy Policy.
What types of discrimination can I report?
You may report various forms of discrimination including based on race, gender identity, or disability.
How can I check the status of my complaint?
You can follow up by contacting the CRD representative who will assist you.
What happens after I submit the form?
An intake interview will be scheduled with a CRD representative.
Can I edit the form after filling it out?
Yes, you can edit the form using our PDF editor before submission.
What documents do I need to submit with this form?
You may need to provide supporting documents that relate to your discrimination claim.
Is there a deadline for submitting my complaint?
It's recommended to submit your complaint as soon as possible to ensure timely processing.