EBD – Northern California Property Eligibility Form

Fill out this form to see if your property qualifies for EBD program support. A local CBO may follow up to discuss next steps and confirm eligibility.

Group Id

Contact Information

First Name

Last Name

Email

Phone Number

Preferred method of contact:

EmailPhoneText

Preferred language:

EnglishSpanishChinese - CantoneseChinese - MandarinVietnameseTagalogOther

Other language:

Property Information

Street

City

State

Zip Code

Property type:

Single-family homeMultifamily (2-4 units)Multifamily (5+ units)

If Multifamily, how many units:

I am the:

OwnerManagerTenant

Tenants: Please note your property owner/manager will be contacted as part of enrollment process.

Property Owner Information

First Name

Last Name

Email

Phone Number

How did you hear about the EBD Northern California program?

Website Event Flyer or door hanger Referred by a group, organization, or person

If referred, please provide name (optional):

By submitting this form, I agree that my contact and property information may be shared with a local Community-Based Organization (CBO) to discuss potential program eligibility. I understand submission does not guarantee eligibility.

Contact Information