Control Number
Tester Type
Site
Test Type
Tester ID
City
State
Zip Code (00000)
Perceived Race / Ethnicity
Sex / Gender
Age Group
Primary Person Who Provided Info
Were you able to meet with an agent to discuss housing options?
If you were not able to meet with an agent, why not?
If no units were available, were you offered to be placed on a waiting list?
After you conveyed your sexual orientation and/or household composition to the agent, were you told that there were no units available or were you unable to obtain rental information?
During your visit, did the agent comment on or make reference to any of the following: Fair Housing Laws, Equal Housing Opportunity, Open Housing Ordinance, or Anti-discrimination Laws?
If the agent made a comment on or made reference to any of the following: Fair Housing Laws, Equal Housing Opportunity, Open Housing Ordinance, or Anti-discrimination Laws?, what was the comment?
Please specify what other personal information volunteered by you, requested by the agent, or not obtained:
The agent said that he/she would contact you
The agent invited you to call him/her
Other (specify)
If other, please specify
This form is complete
Personal information volunteered by you, requested by the agent, or not obtained: Your marital/relationship status
Personal information volunteered by you, requested by the agent, or not obtained: Your household size or composition
Personal information volunteered by you, requested by the agent, or not obtained: Your or your spouse's income
Personal information volunteered by you, requested by the agent, or not obtained: Your or your spouse's occupation
Personal information volunteered by you, requested by the agent, or not obtained: Your or your spouse's length of employment
Personal information volunteered by you, requested by the agent, or not obtained: Your credit standing
Personal information volunteered by you, requested by the agent, or not obtained: Other, specify
Items necessary for application process: Application form?
Items necessary for application process: Credit check?
Items necessary for application process: Criminal background check?
Personal information volunteered by you, requested by the agent, or not obtained: Your rent history
Personal information volunteered by you, requested by the agent, or not obtained: Your address/phone number/e-mail address
Did the agent provide you with: Business Card
Did the agent provide you with: Brochure
Did the agent provide you with: Listings
Did the agent provide you with: Floor Plan
Did the agent provide you with: Rental/Lease Agreement
Did the agent provide you with: Gift
If the agent provided other, specify
Did the agent provide you with: Other
How many TOTAL units were you told were available that had at least your minimum number of bedrooms, were available when you need them, and were below your maximum rent?
How many TOTAL units did you inspect? (Model units inspected may be included in this total.)
Did the agent make any comments on your qualifications to rent (i.e., renters insurance, income verification, etc.)?
If the agent made any comments on your qualifications to rent, what was the comment?
Did the agent provide you with: Food and/or Beverage
Did you meet with the agent:
Items necessary for application process: Co-signer?
Did the agent give you an application to take with you?
Personal information volunteered by you, requested by the agent, or not obtained: Your or your spouse's source of income
Did the agent make any comments about race or ethnicity?
If the agent made any comments about race or ethnicity, what was the comment?
Did the agent make any comments about your household/household composition?
If the agent made any comments about your household/household composition, what was the comment?
Were arrangements for future contact made?
Perceived Sexual Orientation of Agent
Perceived Sexual Orientation
Did you obtain information about housing?
If you did not obtain information about housing, why not? Proceed to Section 3 after answering this question
If you indicated other as the reason for not obtaining information about housing, specify.
Were you able to obtain an appointment?
If you were unable to obtain an appointment, why not?
If you indicated other as the reason you were unable to obtain an appointment, please specify:
Day of the appointment
Date of appointment (mm/dd/yyyy)
Time of appointment (hh:mm)
Location of meeting – specific type (e.g., agent’s office or address of specific home) and actual address
Agent comments re: building/neighborhood: Noise
Agent comments re: building/neighborhood: Safety
Agent comments re: building/neighborhood: Schools
Agent comments re: building/neighborhood: Maintenance/ Services
Did you clearly convey your sexual orientation to the agent with whom you discussed housing before the agent conveyed housing information to you?
If you did not clearly convey your sexual orientation to the agent with whom you discussed housing before the agent conveyed housing information to you, why not?
Please describe how and when you conveyed your sexual orientation:
After you conveyed your sexual orientation to the agent, were you told that there were no units available or were you unable to obtain rental information for a unit(s)?
Did the agent make any comments about persons who are lesbian, gay or transgender?
If the agent make any comments about persons who are lesbian, gay or transgender, what was the comment?
Only for Transgender Testers: For this test, were you instructed by your Test Coordinator to clearly convey your transgender identity to the agent?
If you did not clearly convey your transgender identity to the agent with whom you discussed housing, why not?
If you did clearly convey your transgender identity to the agent with whom you discussed housing, please describe how you conveyed your transgender identity:
Did you clearly convey your sexual orientation to the person you reached at the beginning of the call and/or phone/email message?
After you conveyed your sexual orientation and/or household composition to the agent, were you told that there were no units available, were you unable to obtain rental information for a unit(s), or did the agent hang up?
If after you conveyed your sexual orientation and/or household composition to the agent, you were told that there were no units available, you were unable to obtain rental information for a unit(s), or the agent hung up, please specify:
Please indicate what language you used to reference your partner/spouse:
How many actual available units were inspected?
How many model units or other units (similar to the actual available unit) were inspected?
For safety reasons or otherwise, was it necessary for you to prematurely end your site visit prior to obtaining all necessary information about available housing?
If for safety reasons or otherwise, was it necessary for you to prematurely end your site visit prior to obtaining all necessary information about available housing, please describe:
Only for Transgender Testers: After you conveyed your transgender identity to the agent, were you told that there were no units available or were you unable to obtain rental information for a unit(s)?
If Yes: did you clearly convey your transgender identity to the agent with whom you discussed housing?
At what point in the conversation did you convey your transgender identity to the agent?
If you indicated other as the point in the conversation when you conveyed your transgender identity to the agent, please specify:
Did the agent ask about or make reference to your gender/gender expression/transgender identity, or misconstrue your gender during the course of your meeting?
If the agent asked about or made reference to your gender/gender expression/transgender identity, or misconstrue your gender during the course of your meeting, please describe what the agent said.
If Yes, please also describe how you responded to the agent’s inquiry or reference, or if you corrected the agent about your gender/gender expression/transgender identity.
At what point in the conversation did the agent ask about or make reference to gender/gender expression/transgender identity, or misconstrue your gender?
If you indicated other as the point in the conversation when the agent ask about or make reference to gender/gender expression/transgender identity, or misconstrue your gender, please specify: