Tenants' Rights Clinic Intake

Select Place & Time


Provide Personal Details
This information will remain confidential and is only used to assess whether you qualify for our services.
Personal 





mm/dd/yyyy













Address & Household Information











Contact 






Financial


Attach Documents
Please upload documents relevant to your legal issue. In addition, we need to verify your household’s income to confirm that it is within the income limits for our free legal services (the documentation will not be shared outside of our organization). 

Please upload a copy of any of the following for each adult household member:
  • Photo of a public benefits card (i.e., Medi-Cal and/or CalFresh)
  • Recent paystub  
  • Bank statements 
  • W-2 or tax returns
  • Proof of retirement benefits
  • Proof of SSI, SSDI, or short-term disability
  • Proof of unemployment benefits, worker’s compensation, or any other public benefits. 

Certify and Sign