BRHP | Mediation Request Form

Mediation Request Form

Counseling

Use this form to request a 30 minute Zoom appointment with a BRHP Counselor, tenant, and landlord. Upon submission, a counselor will reach out to schedule the mediation at a time that works for all parties. Completion of this appointment requires participation from both parties. Once scheduled, the Counselor must be informed at least 24 hours in advance if the appointment cannot be kept by either party. The appointment may be rescheduled one time.
Request for Landlord/Tenant Mediation
Assisted Address*
Street Address Address Line 2 City State ZIP Code
Reason for Mediation*
- Communication issues
- Late or Non-Payment of Rent
- Unpaid Utilities
- Neighborhood Disturbance
- Tenant Damages to the Unit
- Landlord Unresponsive
- Landlord Neglect of Property
- Other
Provide a brief background of the reason:
Mediation is requested by:
Tenant Information
Tenant Name*
First Last
Phone
Email*
Property Partner Information
Property Partner Name/Organization Name*
Phone
Email*
Document Upload
Drop files here or

Max. file size: 50 MB, Max. files: 5.
Upload any photos or documents relevant to the mediation inquiry.