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Home
About
What Is Fair Housing?
Programs and Services
Service Areas
News & Events
Donate
Get Involved
Contact
COVID-19 Resources
Fair Housing Conference 2024
Poetry Contest 2024

Request Assistance

* Indicates required field

Name *

First

Last

Email *

Provide your best daytime phone number(s) on the right.

Which Number Do You Prefer? *

Home Mobile/Alternate

Home Phone Number *

Mobile / Alternate Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Preferred Language: *

English Spanish Tagalog Other

Are You A: *

Renter Homeowner Housing Professional / Landlord

Are You Concerned About *

Housing Discrimination Foreclosure Prevention Other (provide detail below)

Level of Urgency: *

Extremely Urgent (loss of home imminent) Important Low Urgency

Please give us a guideline as to the urgency of your request. Our goal is to provide an answer to all inquiries within 2 business days, however we will attempt to answer extremely urgent requests sooner.

The following questions are optional. All answers will be kept confidential.

Annual Household Income *

Number of people in household *

Does anyone in the household have a disability (physical, mental, or both)? *

Yes No Choose not to respond

Gender *

Race *

Ethnicity *

Comment *

Provide us with a short summary of your situation.

Submit

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San Rafael, CA 94901

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Home
About
What Is Fair Housing?
Programs and Services
Service Areas
News & Events
Donate
Get Involved
Contact
COVID-19 Resources
Fair Housing Conference 2024
Poetry Contest 2024