Legal Eviction Prevention Assistance Intake Form
As part of the U.S. Department of the Treasury Emergency Rental Assistance Program; VCLA has created a tenant counseling attorney panel. Volunteer attorneys will provide counseling to tenants with inability to pay rent due to COVID-19.
Name (First, Last) *
Date *
Email *
Phone Number *
List the Best Days and Hours to Contact you *
Household Definition
For the purposes of this form, a household is determined for those who depend on the income amount provided. For example, the people that are listed in your tax return.
Please read the paragraph below then select whether it is applicable to you.
One or more individuals within the household has qualified for unemployment benefits or experienced a reduction in household income, incurred significant costs, or experienced other financial hardship due directly or indirectly to the COVID-19 outbreak; One or more individuals within the household can demonstrate a risk of experiencing homelessness or housing instabilityThe household has a household income at or below 80% of area median income (See Chart below).
Applicability to me. *
80% of area median income Chart
Number of People in the Household *
Have you been served with a written eviction notice? *
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This form was created inside of Report Abuse