Please complete the survey below.

* 1. What is your living situation?

* 2. What is your type of household?

* 3. Do you or any member of your household have a disability?

* 4. If yes, is the disability

* 5. Do you feel you ever experienced housing discrimination while a resident of Moreno Valley?

* 6. Which of the following best describes the person you feel discriminated against you?

* 7. What did you feel that person did to discriminate against you?

* 8. Why do you believe you were discriminated against? Because of your -

* 9. Do you know to whom you would report housing discrimination?

* 10. If yes, who would you report the housing discrimination to?

* 11. Please check the box that best describes your race:

* 12. Please check the box that best describes your ethnicity: Of Hispanic, Latino or Spanish Origin?

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