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Tenant Intake Form
Please fill out the questions below and click submit. Someone from ICC's housing justice team will be in touch with the community member by end of business day.
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Community Member Name:
*
Your answer
Address:
*
Your answer
Zip Code:
*
Your answer
Phone #:
*
Your answer
Language Spoken:
*
Your answer
Email:
Your answer
Description of community member needs from housing justice organizer (describe situation/ purpose of referral):
*
Your answer
Your Name, Department, and Date:
*
Your answer
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