Global WP FORMS

Form 1

Name
Address
By signing up, you agree to receive occasional emails from The Up Center about news, events, and updates. You can unsubscribe at any time. We respect your privacy and will never share your information without your consent.

Form 2

For all other inquiries, complete the form below.
Name
By signing up, you agree to receive occasional emails from The Up Center about news, events, and updates. You can unsubscribe at any time. We respect your privacy and will never share your information without your consent.

Form 3

Your Name
Address
By signing up, you agree to receive occasional emails from The Up Center about news, events, and updates. You can unsubscribe at any time. We respect your privacy and will never share your information without your consent.
Name of Child
Name of Referral
Checkboxes

Form 4

Name
City of Residence

Form 5

Name

Form 6

Name
By signing up, you agree to receive occasional emails from The Up Center and Military Family Clinic about news, events, and updates. You can unsubscribe at any time. We respect your privacy and will never share your information without your consent.

Form 7

Name
By signing up, you agree to receive occasional emails from The Up Center about news, events, and updates. You can unsubscribe at any time. We respect your privacy and will never share your information without your consent.
I am interested in...

Form 8

Name
Adult #2 Name
Address
Do you have stable income?

Form 9

For all other inquiries, complete the form below.
Name
By signing up, you agree to receive occasional emails from The Up Center about news, events, and updates. You can unsubscribe at any time. We respect your privacy and will never share your information without your consent.
My Interest Level

Form 10

Name

Form 11

Step 1 of 8

The Up Center Logo

APPOINTMENT CHECKLIST

Housing and Financial Counseling Department

Client 1 Name
Client 2 Name

Please provide the following items with your intake packet.

Photo ID

Driver’s License/ DMV ID card/ Passport

Housing Verification

Mortgage Statement/ Deed/ Lease Agreement

Proof of Income

Paystubs/ Pensions/ Alimony/ Child Support/ SSI/ Unemployment

Bank Statements

Last 60 days (not transaction reports)

Home Inspection Acknowledgement

Please download HERE, sign, and upload.

Lender Coorespondence(s)*

Correspondences from lender (Mortgage Delinquency counseling only*)

By initialing the boxes below, you confirm that you have reviewed these documents in the resource packet.

10 Important Questions to Ask Your Home Inspector

Renter's Insurance - Consumer's Guide

Lead Brochure

Tenant Rights and Responsibilities

Virginia Fair Housing Law Brochure

By initialing the boxes below, you confirm that you understand that we require these forms to be signed and returned, or acknowledged through email, once received after your counseling session.

For Your Protection, Get a Home Inspection

Action Plan

Budget

Appointment Policies

Cancellations/Rescheduling, Late Appointments and No Shows

We understand that times arise when you may need to miss an appointment due to an emergency or other obligation for work or family. For times such as these, we ask that you advise us of the change so that the department can schedule another client requesting services. Please take the time to review the policy below:

Cancellation/Rescheduling Policy

  • All cancellations and reschedules require 24-hour notice. You will need to contact your counselor by phone or email.
  • A maximum of 2 changes/reschedules can be made on your behalf.

Late Appointment Policy
Please make every effort to be on-time or early to your appointment, however we do realize delays can happen.

  • Arriving within 15 minutes of your appointment time will still allow you to be seen.
  • Arriving more than 15 minutes late will require a reschedule.

No Show Policy

  • 1st time – results in a waiting period of 30 days before a new appointment will be scheduled.

After 2 no call/no show appointments, we will be unable to schedule any future appointments, however a list of agencies providing similar services will be provided to you.

We appreciate your understanding and cooperation. If you have any questions or concerns regarding these policies, please feel free to speak with your counselor directly.

-Housing and Financial Counseling Team

Form 12

Step 1 of 3

Personal Information Client Intake Form

Note: If you have an impairment, disability, language barrier, or otherwise require an alternative means of completing this form or accessing information about housing counseling, please talk to your housing counselor about arranging alternative accommodations.

Applicant Information

Name
Gender
Address
Do you live in a rural area?
Preferred Method of Contact
Are you English Proficient?
Highest Level of Education
Race
Ethnicity
Are you a Veteran?
Are you Disabled?
Appointment Preference

Secondary Applicant Information

Name (Applicant 2)
Gender (Applicant 2)
Preferred Method of Contact (Applicant 2)
Are you English Proficient? (Applicant 2)
Race (Applicant 2)
Ethnicity (Applicant 2)
Are you a Veteran? (Applicant 2)
Are you Disabled? (Applicant 2)

Form 13

Name

Form 14

By signing up, you agree to receive occasional emails from The Up Center about news, events, and updates. You can unsubscribe at any time. We respect your privacy and will never share your information without your consent.
I am interested in...

Form 15

Name
Address

For more information about other opportunities for giving, please contact Kathleen Guzman, Development Coordinator, kathleen.guzman@theupcenter.org or call: 757-965-8696. Please keep a copy of your receipt for tax filing purposes.

The Up Center is a 501 (c) (3) nonprofit organization.  Your contribution is tax-deductible as permitted by law.  For your IRS records, please note that you have received no goods or services for this kind donation. A copy of our annual report can be found on our website, www.theupcenter.org.

By signing up, you agree to receive occasional emails from The Up Center about news, events, and updates. You can unsubscribe at any time. We respect your privacy and will never share your information without your consent.

Form 16

Name
By signing up, you agree to receive occasional emails from The Up Center about news, events, and updates. You can unsubscribe at any time. We respect your privacy and will never share your information without your consent.
What kind of help are you looking for? (Select all that may apply)

Form 17

By signing up, you agree to receive occasional emails from The Up Center about news, events, and updates. You can unsubscribe at any time. We respect your privacy and will never share your information without your consent.

By submitting this form you allow consent to receive SMS from The Up Center. Frequency may vary. Message & data rates may apply. Reply STOP to opt out of further messaging or reply HELP for more information. View our terms and privacy policy at our website.

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