Ownership/management interest in the property
—Please choose an option—Landlord/property owner who self manages the propertyIndividual property managerCorporate property managerRealtorIn-house leasing specialistOther (such as a relative of the property owner)

Please describe the current housing issue with your tenant.

Have you been financially impacted by COVID-19?
YesNo

If yes, briefly describe how you or someone in your household has been impacted.

Do you have a child or children under the age of 18 or 18 and still in high school living in your home?
YesNo

If yes, how many and what are their ages?

Are there household members over the age of 60 who are also on the rental lease?
YesNo

Are you behind in rent?*
yesno

Please understand we are not a rental assistance agency. We provide free legal help for tenants at risk of eviction
If yes, how far behind are you (i.e., how many months):

If you are behind in rent, have you applied for rental assistance from an agency?
yesno

If so, where?

Have you received any type of notice to vacate from your landlord or an eviction summons? yesno

If yes, please tell us what the notice says:

Please let us know anything else you think is important.