UHA Complaint Form (Spanish)
Utilice este formulario para enviar una queja por escrito a Umpqua Health.
UHA Complaint Form
Use this form to submit a written complaint to Umpqua Health.
CHIP Application Budget Form
Form W-9
HRSN Nutrition Service Request Form
Use this form to request nutrition assistance services.
HRSN Housing Service Request Form
Use this form to request housing assistance services.
HRSN Climate Service Request Form
Use this form to request a climate device (such as an air conditioner or portable heater).
UHA Information Sharing Authorization Form
This form gives us permission to send details about your HRSN service request to one of our partners.
Verification of Landlord/Tenant Relationship and Rent Owed
HRSN Housing Supplemental Income Worksheet
Use this form if you need to share income information for other adults in your home as part of your HRSN request.
CHP Funding Webinar Slides 2025
Learn more about funding opportunities associated with the 2025 Community Health Improvement Plan (CHP).
UHA Community Health Improvement Plan
The CHP is a five-year plan to systematically address community health issues based on the Community Health Assessment (CHA).