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* 1. What is your living situation?

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* 2. In what type of housing do you live?

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* 3. Please indicate the zip code of where you live:

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* 4. What is your type of household?

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

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* 6. If you answered yes to Question 5, please indicate the type of disability:

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* 7. Have you ever experienced housing discrimination while a resident of Hemet?

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

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

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

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

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

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

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

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