Bay Area Eviction and Displacement Survey
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What is the address or intersection of the home you are/were being forced out of?

 
Original street:

 
Original city:

 
Original zip code:

 
When did you move into this residence?

 
What is the total number of people being/that were forced out of the residence?

 
Did/do children (under 18) live with you?

     
 
If yes, their ages

 
How many units were/are in your building?

 
What was/is your personal share of monthly rent?

 
What was/is your household's total monthly rent?

 
Who was/is the landlord?

Include as much information as possible. If more than one landlord was involved, please separate information with commas.
 
Landlord name:

 
Landlord street:

 
Landlord city:

 
Landlord website:

 
Landlord phone number:

 
Who was/is the property manager?

 
Is/was your unit subject to rent control?

For more information on San Francisco's rent control coverage and regulations, please visit http://www.sftu.org/rentcontrol.html

 
Which tactics are/were being used to force you to leave your home?

 
Choose as many as apply:


 
We would love to hear the story of your displacement. Please tell us more below:

 
Have you already moved?

     
 
If you have already moved, please answer the following questions as completely as possible. If you have not, you may skip this section.

 
Please describe your current living situation:


 
If you selected "Other," please elaborate:

 
Where did you move?

 
Relocation address or intersection:

 
Relocation city:

 
Relocation state:

 
What is the approximate date that you moved?

 
What is the current rent that you pay post relocation?

Please provide your monthly, individual share of rent.
 
How many miles do you commute to work/school/etc.?

 
How many miles did you commute before you moved?

 
Tell Us About Yourself

The following questions will help us get a better understanding of who is being affected by displacement in the Bay Area.
 
What is your race/ethnicity?


 
What is your gender?


 
What is your sexual orientation?


 
What is your yearly income?


 
What is your age?


 
Are you disabled?

     
 
Is there anything else you would like us to know?

 
Would you like to remain anonymous on our public map?

     
 
If you would like your name to appear on our map, please list it below:

 
If you are comfortable with someone from the Anti- ­Eviction Mapping Project contacting you with follow-­up questions for our oral history project and other future undertakings, please list your preferred contact information:

Your contact information will not be made public.
Thank you tremendously for your participation. Please spread the word and pass this form on to others who have been evicted or threatened with eviction. For more information about the Anti-Eviction Mapping Project, please visit our website at:
 
www.antievictionmappingproject.net
Anti-Eviction Mapping Project
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