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? Yes No
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? Yes No
If yes, please explain:

By checking this box I/we acknowledge that CDE is in the process of converting to a no-smoking property.
By checking this box I/we understand we should receive a letter with in 2 weeks. Please contact us at that time if you do not receive the letter.

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