This information helps the counselor understand the issues in your case. Intake Form Name* First Last Email* Affected Address* Street Address Address Line 2 City ZIP Code Phone*Current Rent for the Entire Unit: $*Amount You Pay: $*Number of Units in Your Building:*Your Unit:*1BR2BR3BRotherDo you live with Roommates?:*YesNoHow Many Roommates?Lease Start Date?* Date Format: MM slash DD slash YYYY Lease End Date?* Date Format: MM slash DD slash YYYY Condition of Building:*PoorFairGoodGreatLandlord/Mgmt Company:*Manager:*What is the main Problem you are here for?:*RepairsRent IncreaseSecurity DepositRoommates/ NeighborsLease QuestionsSub-lease QuestionsLandlord HarassmentEvictionOtherReason for EvictionOther Reason DescriptionHow did you hear about IVTU?*FriendDaily NexusOn CampusRadioFlyerOtherPlease let us know how you heard about IVTUBriefly State the Nature of your ProblemMessageCaptcha