Form Center

2. Purpose of this Form
   Please use this form to request an appointment to speak with a Rent Program staff member. Once submitted, you will receive a confirmation message from a member of our team with your appointment time. Please note, due to the high volume of requests at this time, appointments are limited to 30 minutes. The degree to which you complete this form completely and accurately may affect the quality of assistance we can provide. Thank you in advance for your understanding.
4. Name:*
5. Phone Number:*
7. Email Address:
9. Add my email to Listserv

   Check this box if you would like to be added to the Rent Program email message list (listserv).

   1. YES, add me to the list!
11. Identity (check all that apply):*

    1. Tenant
    2. Landlord
    3. Property Manager
    4. Realtor
    5. Attorney
    6. Other
12. Preferred Language:*

    1. English
    2. Spanish
    3. Mandarin
    4. Cantonese
    5. Arabic
    6. Other
14. Property Address in Question*
16. City*
17. State

    California

18. Zip*
20. Description of Property (check all that apply):*

    Please check all boxes that describe the rental property in question.

    1. Single Family Home
    2. Condominium
    3. Duplex
    4. Triplex
    5. Fourplex
    6. Apartment Building
    7. Affordable Housing
    8. New Construction (property was permitted on or after February 1, 1995)
    9. Accessory Dwelling Unit (In-Law Unit)
    10. Converted Garage
    11. Bedroom in a Shared House
    12. Hotel or Motel Room
    13. Unpermitted Structure
22. Description of Question*

    Please check all boxes that describe or relate to the question you have for the Rent Program. Please note, some questions may extend beyond the scope of the Rent Program and you may receive a referral to another agency for further assistance.

    1. Questions about my rights and responsibilities regarding evictions
    2. I received an eviction notice (tenants only)
    3. Questions about my rights and responsibilities regarding rent
    4. Questions about a letter or notice I received
    5. Questions about habitability/property maintenance
    6. Questions about the Rent Adjustment Petition process
    7. Questions about rent relief resources
    8. Questions about a security deposit
    9. Questions about the Rent Program in general
    10. Questions about the Rental Housing Fee or an invoice I received
    11. Questions about Property Enrollment or Tenancy Registration
    12. Questions about the Rent Board
24. Please use the space below to further describe your issue or question (optional)
26. Attachments (optional)
    Use the button above to upload any documents (notices, letters, leases, etc.) relevant to your question. Please note that these documents may be subject to disclosure pursuant to a Public Records Act request.
28. Counseling Session Type*

    Please select the option below that best meets your needs.

    1. I want to discuss my questions over the phone (NOTE: We will contact you from a blocked number at your appointment time. Please ensure your phone will accept a call from a blocked number.)
    2. I want to discuss my questions over video (e.g. Zoom)
    3. I want to discuss my questions in-person (440 Civic Center Plaza, Suite 200, Richmond, CA)
30. Your Availability*

    Please check the box next to the timeframes that work best for your schedule. We will email or call you to confirm your appointment time.

    1. Mondays between 9 AM and 12 PM
    2. Mondays between 1 PM and 4 PM
    3. Tuesdays between 9 AM and 12 PM
    4. Tuesdays between 1 PM and 4 PM
    5. Wednesdays between 9 AM and 12 PM
    6. Wednesdays between 1 PM and 4 PM
    7. Thursdays between 9 AM and 12 PM
    8. Thursdays between 1 PM and 4 PM
    9. Fridays between 9 AM and 12 PM
    10. Fridays between 1 PM and 4 PM
32. How did you hear about the Richmond Rent Program?*

    1. Google Search
    2. Referral
    3. Word of Mouth
    4. Received a Notice from Landlord/Property Manager
    5. Received a Notice from Rent Program/City Department
    6. City of Richmond Website
    7. Other
34. If you selected Other, please specify:
36. Additional Schedule Notes (optional):
Leave This Blank:


38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit

* indicates a required field