Tenant Advocacy Intake Form | Economic Action MD Fund

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Tenant Advocacy Intake FormCarol Ott2026-07-30T12:55:19-04:00

PLEASE NOTE: WE DO NOT PROVIDE FINANCIAL ASSISTANCE OF ANY KIND.

If you are a tenant and you are being evicted for failure to pay rent, please call 211 and ask for the Coordinated Eviction Prevention Intake/ACE Program.

Please note: We do not offer any financial assistance programs. If you need assistance with an eviction related to failure to pay rent, please call 211 and ask for the Coordinated Eviction Prevention Intake.

"*" indicates required fields

X/Twitter

This field is for validation purposes and should be left unchanged.

I am a...*

Your First and Last Name*

Tenant's or Landlord's First and Last Name*

Your Race*

American Indian or Alaska Native

Asian

Black or African-American

Native Hawaiian or Pacific Islander

White

Are you Hispanic or Latino/Latina?*

Yes

No

Client's Race*

American Indian or Alaska Native

Asian

Black or African-American

Native Hawaiian or Pacific Islander

White

Is client Hispanic or Latino/Latina?*

Yes

No

Your Gender*

Female

Male

Transgender

Non-Binary/Other Gender

Your Age*

Client's Gender*

Female

Male

Transgender

Non-Binary/Other Gender

Client's Age*

Your Yearly Household Income (including all adults who reside with you)*

Please enter a number from 0 to 1000000000.

Client's Yearly Household Income (including all adults who reside with you)*

Monthly Rent Payment*

Client's Monthly Rent Payment*

Number of Adults Living in the Home*

Number of Children Living in the Home*

Do you receive a housing subsidy? If yes, indicate which type (HCV, LIHTC property, etc.)*

Does client receive a housing subsidy? If yes, indicate which type (HCV, LIHTC property, etc.)*

Do you have a disability?*

Yes

No

Does client have a disability?*

Yes

No

Your Email Address*

Client's Email Address*

Street Address of the Property You're Contacting Us About*

Street Address Address Line 2 City ZIP Code

County or City*

Name and Address of Property Management Company/Landlord*

Please describe your landlord-tenant issue here. Please be as detailed as possible. (5000 character maximum)*

Please re-type your first and last name here. You affirm and certify that all the information and answers to questions herein are complete, true and correct to the best of your knowledge and belief. If you are filling this out on behalf of someone else, you would need to include your own name.*

Which organizations have you contacted about this issue before contacting us?*

How did you hear about us?*

If your total household income is $30,000 or less, would you be interested in hearing from a member of our SOAR team regarding a benefits checkup or the Maryland Renter's Tax Credit?*

Benefits Checkup Only

Renters Tax Credit Information Only

Both

None

Phone Number*

Δ

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Founded in 2000, Economic Action Maryland Fund (formerly the Maryland Consumer Rights Coalition) is a leading force for economic justice. We are a statewide nonprofit movement of individuals and organizations that advances economic inclusion and financial justice through research, advocacy, consumer education, and direct service.

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