Submitting An Application

An application must be completed in order to assist Westside Regional Center in determining eligibility for the Lanterman Developmental Disabilities Services Act. Below you can find all the necessary forms required for Westside Regional Center to initiate the evaluation process. To begin the process:

STEP 1

Download and complete the application as accurately as possible.

• English Application
• Spanish Application

Step 2

The following consent forms will need to be completed and submitted along with the application. Sign the consent forms for evaluation and services. The evaluation process cannot begin prior to receipt of your written consent. Please contact Noemi Iribe at Noemii@westsiderc.org or (310) 258-4121 with questions regarding these forms.

Step 3

Fill-in, print out, sign, and submit the entire application and the consent forms to WRC’s Intake Department. Upon submitting a completed application packet, an Intake Counselor will be assigned to your child’s case and they will contact you to schedule an intake appointment.

The application can be submitted via:

• In-person to the receptionist at Westside Regional Center
• Email: IntakeOverAge3@westsiderc.org
• Fax: (310) 338-9597
• US Mail:

Need Help Filling Out Your Application?

Application questions can be answered by our culturally sensitive staff. Call Noemi Iribe at (310) 258-4121 or email her at Noemii@WestsideRC.org.