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Rent Program Appointment Request Form

  1. 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.
  2. Add my email to Listserv
    Check this box if you would like to be added to the Rent Program email message list (listserv).
  3. Identity (check all that apply):*
  4. Preferred Language:*
  5. State


  6. Description of Property (check all that apply):*
    Please check all boxes that describe the rental property in question.
  7. 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.
  8. 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.
  9. Counseling Session Type*

    Please select the option below that best meets your needs.

  10. 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.
  11. How did you hear about the Richmond Rent Program?*
  12. Leave This Blank:

  13. This field is not part of the form submission.