Get Ca Westside Regional Center Intake Application 2020-2025

This guide provides comprehensive instructions on filling out the CA Westside Regional Center Intake Application online. By following these steps, users can ensure they submit accurate information for eligibility assessment for services under the Lanterman Developmental Disabilities Services Act.

Follow the steps to complete your application accurately

1. Press the ‘Get Form’ button to access the application and open it for filling out.
2. Begin with the applicant's information section. Fill in the applicant’s last name, first name, middle initial, and any other names used.
3. Provide the applicant’s date of birth and select their gender. Make sure to enter the Social Security Number (SSN) accurately.
4. Indicate whether the applicant has previously received services from the Westside Regional Center or another Regional Center by selecting 'Yes' or 'No'. If 'Yes', include the name of the Regional Center.
5. Complete the race/ethnicity section by selecting all options that apply to the applicant.
6. In the language section, mark all languages that the applicant speaks.
7. Fill out the insurance information, ensuring to provide all relevant plan names and numbers needed for the appointment.
8. Provide accurate information for the self, parent, or legal guardian, including their relationship to the applicant.
9. For any alternate contacts, fill in the required details, including their relationship to the applicant.
10. In the reason for referral section, briefly outline any concerns or reasons for submitting the application.
11. Select applicable conditions from the list provided to indicate which developmental disabilities apply to the applicant.
12. Attach any additional documents that may assist in understanding the applicant’s needs, such as medical or educational records.
13. Review the application for completeness and accuracy before saving the changes, downloading, or printing the application. Ensure to retain a copy for your records.

Begin completing your CA Westside Regional Center Intake Application online today to ensure accurate submission.