260 North Third Avenue
Upland, CA 91786
P: (909) 981-7160

Online Application

In addition to completing the online application, it is highly recommended that applicants contact the office to receive detailed information regarding income limits, wait-lists, deposits and documents that would be required.
Applicant Information:
Name:
Address:
City:
State:
Zip:
Phone:
Email:
   
Starting with the head of household, list all family members who will be
living with you, including yourself:
1st Tenant:
Full Name:
Birth Date:
Age:
   
2nd Tenant:
Full Name:
Birth Date:
Age:
   
Income - list sources and amounts of all income, such as employment, social security, retirement pensions, interest in savings, etc.:
1st Tenant:  
Name:
Source of Income:
Monthly Amount From Income:
Annual Amount From Interest:
   
2nd Tenant:  
Name:
Source of Income:
Monthly Amount From Income:
Annual Amount From Interest:
   
General Questionaire:
Why are you interested in moving into a senior housing complex?
If you are not a resident of Upland, do you have a relative living or working in Upland?
If yes, please list the Name, Address, Phone Number, and Relationship for each:
How much are you currently paying for rent?
$
What utilities do you currently pay for?
Have you or anyone planning to live in your household been convicted of a criminal offense?
If yes, please explain:
By checking this box I/we acknowledge that CDE is in the process of converting to a no-smoking property.