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Tenant Advocacy Intake Form
Carol Ott
2024-11-05T11:27:32-05:00
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" indicates required fields
I am a...
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Tenant
Landlord
Neither
Your First and Last Name
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Tenant's or Landlord's First and Last Name
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Your Race
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American Indian or Alaska Native
Asian
Black or African-American
Native Hawaiian or Pacific Islander
White
Are you Hispanic or Latinx?
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Yes
No
Client's Race
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American Indian or Alaska Native
Asian
Black or African-American
Native Hawaiian or Pacific Islander
White
Is client Hispanic or Latinx?
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Yes
No
Your Gender
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Female
Male
Transgender
Non-Binary/Other Gender
Your Age
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Client's Gender
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Female
Male
Transgender
Non-Binary/Other Gender
Client's Age
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Your Yearly Household Income (including all adults who reside with you)
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Client's Yearly Household Income (including all adults who reside with you)
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Monthly Rent Payment
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Number of Adults Living in the Home
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Number of Children Living in the Home
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Do you receive a housing subsidy? If yes, indicate which type (HCV, LIHTC property, etc.)
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Does client receive a housing subsidy? If yes, indicate which type (HCV, LIHTC property, etc.)
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Do you have a disability?
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Yes
No
Does client have a disability?
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Yes
No
Your Email Address
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Client's Email Address
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Street Address of the Property You're Contacting Us About
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Street Address
Address Line 2
City
ZIP Code
County or City
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Allegany
Anne Arundel
Baltimore City
Baltimore County
Calvert County
Caroline County
Carroll County
Cecil County
Charles County
Dorchester County
Frederick County
Garrett County
Harford County
Howard County
Kent County
Montgomery County
Prince George's County
Queen Anne's County
Somerset County
St. Mary's County
Talbot County
Washington County
Wicomico County
Worcester County
Name and Address of Property Management Company/Landlord
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Please describe your landlord-tenant issue here. Please be as detailed as possible. (5000 character maximum)
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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.
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Which organizations have you contacted about this issue before contacting us?
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How did you hear about us?
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Would you be interested in receiving first-time homebuyer information from a member of our staff?
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Yes
No
Email
This field is for validation purposes and should be left unchanged.
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