Survey conducted by Action Alameda News.

Please complete the survey once for every rent increase you wish to document. e.g. if you wish to document two increases in the past two years, fill out the survey twice with the same address and contact info.

At a future date, Action Alameda News will publish the survey results and share with the City of Alameda.

* 1. Location in Alameda. e.g. "100 Block, Main St." (No need to enter exact address.)

* 3. How long have you lived at this address? (In years.)

* 4. Date of Last Rent Increase

Date / Time

* 5. Prior rent amount, before this increase. $

* 6. New rent amount, after this increase. $

* 7. Are you willing to provide documentation of your rent increase? (Provide your e-mail address. You can also send copies of your rent increase notice This documentation will not be published - it will only be used to verify the data you entered.)