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In Person Counseling Form for Members
Call the member line except fill out this form and come in for urgent or complicated questions.
Your Information
Today's Date*
Email Address*
Last Name*
First Name*
Current Address*
Apartment Number
City*
State
Choose one...
Alabama
Alaska
American Samoa
Arizona
Arkansas
Armed Forces America
Armed Forces Europe
Armed Forces Pacific
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
United States Minor Outlying Islands
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Current Zip Code*
Cell Phone
Home Phone
Address where problem occured (if different than current)
Problem Zip Code
Are you a senior (60 years old or over)?
Yes
No
Is there a school worker in the household or family?
Yes
No
Are you disabled?
Yes
No
How did you hear about the Tenants Union?
Are you a family with children?
Yes
No
Individual Income for 2021:
(Choose one)
$0-$39,150 (qualifies for low income membership)
$39,151-$65,250
$65,251-$104,400
$104,401 and over
Rent for Entire Apartment/House
Your Rent If Different from Entire Apartment/House
Rental Unit Information
Is your building under the SF Rent Ordinance?
Choose one...
Yes
No
Don't Know
Was your building built before 1979?
Choose one...
Yes
No
Don't Know
Does the government pay a part of your rent?
Choose one...
Yes
No
Don't Know
You rent a(n)...
Choose one...
Apt/Flat
Condo
Room
House/Only unit on property (including illegal/vacant)
Your rent is paid to:
Choose One
Owner
Another Tenant
How many units in your building?
How many bedrooms in your unit?
Condition of Building?
Poor
Fair
Good
Great
Landlord's Name
Landlord's Address
When did you move in?
Main Problem: (You may choose more than one)
Coronavirus-Related
Yes
No
Eviction
Yes
No
Type of Eviction (if applicable)
Choose one...
Owner or Relative Move In
Ellis Act
Master Tenant Moving Out
Non-Payment
Nuisance
Extreme Rent Increase
Illegal Subletting
Breach - violation of lease
Loss of storage or garage
Yes
No
Buyout
Yes
No
Owner Passthrough of costs
Yes
No
Adding / Replacing Roommates
Yes
No
Temporary Move for Construction
Yes
No
Sale of Building
Yes
No
Security Deposits
Yes
No
Roommate or Neighbor Dispute
Yes
No
Rental Agreement
Yes
No
Rent Increase
Yes
No
Pets / Assistance Animals
Yes
No
Repairs / Pests / Mold
Yes
No
Harassment by Landlord
Yes
No
Summary of Problem (If Necessary)
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Submit Intake Sheet
You should receive an email in a few minutes of your intake sheet. Please come to the clinic,
https://sftu.org/drop-in-clinic
.