Upland Housing Authority
Serving the Community of Upland Since 1943

 

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This website was updated on:
August 11, 2016

 

Public Housing Applicant Change of Household Size and Other Information

 

WARNING: This form is for Public Housing only.  

If you are not on the waiting list for UHA's Public Housing program, or if you are a current program participant, do not use this form.  You will not receive a response to the information you submit using this form.

To find out if you are on UHA's waiting list, go to www.waitlistcheck.com and log in with the head of household's 4-digit year of birth and Social Security Number.

 

INSTRUCTIONS:

  1. This form must be completed by the head of household listed on the pre-application.

  2. Answer the questions below, then read the certification statement and click the Submit button.

  3. Please allow a minimum of 30 days for UHA to process the update.  UHA cannot provide a receipt.

PLEASE NOTE: UHA cannot respond to requests for waiting list status or tell you your position on the waiting list.  To check the status of your application, go to www.waitlistcheck.com.

Contact Information

Enter the information for the head of household as listed on your pre-application form.

 

First Name

 

 

Last Name

 

 

Social Security Number

 

 

Date of Birth

 


What is your mailing address?

  Street Address  
  Apartment Number  
  City  
  State  
  Zip Code  
  Is this a new address?  Yes


What is your current phone number?

  Home Phone  
  Is this a new phone number?  Yes
  Cell Phone  
  Is this a new phone number?  Yes
  Work Phone  
  Is this a new phone number?  Yes


What is your current size of your household?

  Number of
Adults (18 years old and over)
 
  Number of Minors (under 18 years old)  


What is your total annual household income?  This is the total annual income from all sources for all household members.

  Total annual household income.           $    


Do you live or work in Upland, California?  Please answer Yes or No.

  Is your permanent residence in the City of Upland?  Yes          No
  Are you or your spouse employed in the City of Upland?  Yes          No


Are you a Veteran who served in the active military, naval, or air service, OR are you a surviving spouse of a Veteran?  Skip if answer is No.

  Are you a Veteran or surviving spouse of a Veteran?  Yes


What is your current e-mail address?

 

E-mail Address

 
  Is this a new e-mail?  Yes

 

Please allow a minimum of 30 days for UHA to process the update.  UHA cannot provide a receipt.

PLEASE NOTE: UHA cannot respond to requests for waiting list status or tell you your position on the waiting list.  To check the status of your application, go to www.waitlistcheck.com.

Certification Statement

By clicking submit, I hereby certify under penalty of perjury that the information I have provided on this form is true, correct, and complete.  I understand that the Upland Housing Authority may verify the information provided herein.  I understand that any false or incomplete statements are cause for denial or termination of assistance under the Public Housing program.

 

Updated April 1, 2015

 

Housing Authority of the City of Upland, California

1200 N. Campus Avenue, Upland, California  91786
(909) 982-2649 Telephone    |    (909) 982-0237 Facsimile