SMS Intake - Rentervention

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Manual Intake

1Preliminary Info

2Tenant Info

3Landlord Info

4Referrer Info

Income Eligibility
Household Size*
# in Household | Annual Salary 60% AMI
Tenant Information
Name*
First Last
Legal Issue
Brief Narrative
Please provide a few sentences about the tenant and their issue. This information will be viewable by volunteers and the tenant alike. Also, if you selected 'Other' please fill in the legal issue which may not be on the list, such as: Foreclosure, Lockout, Discrimination, Retaliation, etc.
Select an issue*
- Lockout
- Lockout (Constructive)
- Conditions (Breach)
- Conditions (Essential Services)
- Eviction (Pre-Filing)
- Eviction (Post-Filing)
- Eviction (Post-Judgment)
- Security Deposit
- Other
- COVID-19

Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Email

If they have one, it really, really, helps.

Landlord Information
Is there a management company?
- Yes
- No
Management Company
Landlord Name or Property Manager/Contact*
First Last
Landlord Email
Landlord Phone
Landlord Address
Street Address Address Line 2 City State ZIP Code

Referrer
Name*
First Last
Email

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LCBH provides free, comprehensive legal representation so that renters have a trusted advocate in court. Combined with education, outreach, supportive services and policy initiatives, our programs holistically address both the short-term housing crisis and underlying causes, so that more families can move from a path leading to homelessness to one of safe and stable housing.

Manual Intake

Income Eligibility

Tenant Information

Legal Issue

Landlord Information

Referrer