2024 UWC Assessment

All community members accessing UWC services will need to complete this form. You will be asked to upload a copy of your government-issued identification. (This is not an option, if we don't have an ID with your application you will be asked to complete an affidavit). Our services are only for Trans and Non-Binary identified community members in Los Angeles County and surrounding cities.
Once you complete this assessment, you will be contacted to set up an appointment to continue the assessment.
Email address *
Name (Listed on your ID. You'll be asked to upload it to this form in a few seconds)*

First NameLast Name
If you need assistance with changing your name and or gender marker please indicate that in the notes. We can assist you with this.
Affirming Name (if different from the name on ID)
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*

MonthDayYear
Date
Your Current Age*
Mobile Phone Number*
Our services are open to Transgender and non-binary identified community members only. If you are cis-identified, we can refer you to one of our amazing partners.
How do you identify?*

Trans Masculine - Trans ManTrans Feminine - Trans WomanNon-Binary
What are your pronouns?*

They / ThemHe / HisShe / HerZe / HirOther
Is your housing temporary or permanent?
You will be asked to upload a copy of your ID at the end of this form.
Do you have a valid identification?*
Which service do you need assistance with? *
If you are requesting something different, please let us know what that is. (WE DO NOT ASSIST WITH BILLS, TRAVEL OR RENT)
What is your ethnic background?*
Have you participated with our organization previously? If so tell us about it *
You will need to upload a picture of your identification, You can also bring it with you to your appointment
upload your identification here ( a picture of your ID is ok)

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How did you hear about us?*
Signature

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You will need to upload a picture of your identification, You can also bring it with you to your appointment