Rental Application - Usda/hud Properties Only Page 8
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10USDA/HUD HOUSING APPLICATION
RACE AND ETHNICITY DATA COLLECTION
The following information is requested by the Federal Government in order to monitor
compliance with Federal Laws prohibiting discrimination against applicants seeking to
participate in this program. You are not required to furnish this information, but are
encouraged to do so. This information will not be used in evaluating your application or to
discriminate against you in any way. However, if you choose not to furnish it, we are required
to note the race, ethnicity and sex of applicants on the basis of visual observation or surname.
___ I do not wish to furnish this information
Ethnicity:
___ Hispanic or Latino
___ Not Hispanic or Latino
Race: (Mark all that apply)
___ White
___ Black or African American
___ American Indian or Alaska Native
___ Asian
___ Native Hawaiian or Other Pacific Islander
Sex:
___ Male
___ Female
Non‐Discrimination Statement:
This institution is an equal opportunity provider and employer.
________ Information provided by Management.
Page 8 of 10
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