Eviction Help Center Survey

CITY OF SAN JOSE
Eviction Help Center Survey
All personal identifying information is kept confidential and not used for any other purpose.

       Important Notice

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Is this survey for yourself or others?
Can we send you text?
Are you the head of the household?
Source of income (check all that apply)
Do you receive any of these? (Check all that apply.)
What do you need help with?
Do you think you have received a termination or eviction notice or a Notice to Pay?
Have you received an Unlawful Detainer?
Would you like us to contact you to schedule an appointment?
How did you hear about us? (check all that apply):

DEMOGRAPHIC INFORMATION (Demographic information is used for statistical purposes only. Other information provided in this section is kept confidential.)




Is anyone in your household disabled? (check all that apply)
Has anyone in your household served in the military?

INFORMATION ABOUT YOUR HOUSING ISSUE

What kind of housing do you have? (check all that apply):
Would you like to receive information or referrals to community groups that help organize and empower tenants?
Are you a US Citizen? (Not required to receive services)