Intake Form

If you would like to apply for advice or advocacy from the Fair Housing Center of Greater Boston please complete the following intake form. Please be aware that:

Submitting this intake form does NOT establish an attorney-client relationship between you and the Fair Housing Center of Greater Boston.
You must accurately enter your phone number, provide specific names, and any links or information to advertisements for housing and/or property addresses regarding your complaint, which will to allow us to follow up with you in a timely manner.

If you have any questions, or prefer to submit an intake in person or by phone, feel free to contact .our office at 1.

Client Information

First Name*:

Last Name*:

Street Address*:

City*:

State*:

Zip*:

*Telephone:**	*Alternate Phone:**
*E-mail address:**

Housing Subsidy?:
Yes
No

If yes, please indicate the type of subsidy and the agency that administers your subsidy:

Disability?
Yes
No

Personal Information

Marital Status:	Language:
Race:	Gender:
Ethnicity:	Household Income:
Household Information
Number of Adults:	Number of Children:

Source of Referral: How did you learn about the Fair Housing Center of Greater Boston?

Complaint*: Please provide a brief description of the discriminatory incident below. We ask that you be as specific as possible, and include any names, links to advertisements for housing and/or property addresses that have to do with your complaint.

Intake Form

Intake Form

Intake Form

Client Information

Personal Information

Household Information