* 1. What is your living situation?

* 2. In which city or area do you live?

* 3. What is your type of household?

* 4. Do you or any member of your household have a disability? (Please refer to the description of a disability below)

A disability is a condition that limits major life activities such as caring for oneself, performing manual tasks, seeing, hearing, eating, sleeping, walking, standing, lifting, bending, speaking, breathing, learning, reading, concentrating, thinking, communicating, and working.

* 5. Have you ever experienced housing discrimination while a resident of Orange County? (Please refer to the descriptions of housing discrimination below)

Housing discrimination generally means being treated differently, harassed or being limited in your housing choice because of a personal characteristic covered by law.

Some examples include:
·      Been denied housing for which you believe you were qualified
·      Been asked to move even though you were a good tenant
·      Had trouble receiving services or repairs
·      Encountered advertising that limits a housing choice
·      Been denied a housing loan for which you believe you were qualified
·      Shown limited choices when searching for housing or not shown housing you requested
·      Been denied your request to physically alter housing or the way it is operated because of a need related to a disability

* 6. If you have experienced housing discrimination while a resident of Orange County, did you report it?

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

* 8. Which of the following best describes the person who discriminated against you?

* 9. Where did the discrimination occur:

* 10. What did that person do to discriminate against you?

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

* 12. If yes, who would you report the housing discrimination to? (you may check more than box)

* 13. Please check the box that best describes your ethnicity:

* 14. Please check the box that best describes your race

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