File a Grievance

Grievant's Information

Contact information for person who has grievance

Each phone number text box requires a 10-digit U.S. phone number and allows for an optional extension up to 5 digits long.

Preferred Method(s) of Contact:
Address

Preparer's Information

Are you filing a grievance for someone other than yourself? (Selecting "Yes" will add more fields to this form.) required

Contact information for person completing this form

Each phone number text box requires a 10-digit U.S. phone number and allows for an optional extension up to 5 digits long.

Preferred Method(s) of Contact:
Address

Grievance Location

Is your grievance related to a specific location or housing development? (Selecting "Yes" will add more fields to this form.) required

Address where grievance occurred

Address

Grievance Information

required
Did you file a lawsuit or complaint with another agency or organization about the topic of this grievance?:
Where did you file that complaint?

Multiple dates are separated by commas and spaces (mm/dd/yyyy, mm/dd/yyyy, ...)

Have you received any of the following notices, orally or in writing? If written, please attach a copy.


Notice to Vacate from the Owner/Manager:
Unlawful Detainer (Eviction) Summons from the Court:
Sheriff's Notice to Vacate:
Were you given a date to move out?:
Have you been denied a unit?:
If Yes, is it still vacant?:
If Yes, was it an accessible unit?:
Supporting Documents:

Drop files to upload

Supported File Types:

  • doc
  • docx
  • gif
  • jpeg
  • jpg
  • pdf
  • png
  • ppt
  • pptx
  • txt
  • xls
  • xlsx

Maximum Number of Files: 20

Maximum File Size: 20 MB

Review and Submit

Please review the information entered. To go back and make changes, click the "Previous" button. Click "Finish" to submit the grievance.


1. Grievance Information

Contact information for person who has grievance


First Name:
Middle Name:
Last Name:
Primary Phone Number:
Additional Phone Number:
Email:
Preferred Language:
Preferred Method(s) of Contact:
Other Preferred Method of Contact:
Address
P.O. Box:
P.O. Box Number:
House Number:
Street Name:
Unit Number:
City:
State:
Zip Code:

2. Preparer's Information

Are you filing a grievance for someone other than yourself? (Selecting "Yes" will add more fields to this form.)

Contact information for person completing this form


Relationship to person who has the grievance
First Name:
Middle Name:
Last Name:
Primary Phone Number:
Additional Phone Number:
Email:
Preferred Method(s) of Contact:
Other Preferred Method of Contact:
Address
Provide Address (Selecting the checkbox will add more fields to this form.):
P.O. Box:
P.O. Box Number:
House Number:
Street Name:
Unit Number:
City:
State:
Zip Code:

3. Grievance Location

Is your grievance related to a specific location or housing development? (Selecting "Yes" will add more fields to this form.)
Housing development or location name:

Address where grievance occurred

Address
House Number:
Street Name:
Unit Number:
City:
State:
Zip Code:

4. Grievance Information

Please provide a brief description of the grievance including relevant date(s), name, title and contact information of parties involved, if available, and any additional information.
Did you file a lawsuit or complaint with another agency or organization about the topic of this grievance?:

Where did you file that complaint?

California Civil Rights Department:
Filed Dates:
Court:
Name of the court:
Filed Dates:
Department of Fair Employment and Housing:
Filed Dates:
Fair Housing organization:
Name of organization:
Filed Dates:
HUD:
Filed Dates:
Other:
Describe where the complaint was filed:
Filed Dates:

Have you received any of the following notices, orally or in writing? If written, please attach a copy.

Notice to Vacate from the Owner/Manager:
Unlawful Detainer (Eviction) Summons from the Court:
Sheriff's Notice to Vacate:
Were you given a date to move out?:
If so, by what date?:
Have you been denied a unit?:
If Yes, is it still vacant?:
If Yes, was it an accessible unit?: