Intake Process—Birth to Three Years of Age

In order to determine your child’s eligibility, Westside Regional Center (WRC) will conduct a comprehensive intake process including evaluation of your child’s developmental level and a review of available medical records/history. The application contains all the information required for WRC to initiate the intake process.

Anyone can make a referral, including parents, legal guardians or conservators, medical care providers, neighbors, family members, foster parents, and day care providers. Professionals and concerned persons may make a referral, however, permission of the individual, parent or legal guardian is necessary. Legally ordered evaluations may come from the courts or Department of Children and Family Services.

The first step that parents may take is to discuss their concerns with their health care provider/doctor. Parents may apply for the Early Start Program by submitting an application.

How Can I Apply?

Westside Regional Center (WRC) will initiate an intake process to determine if your child meets eligibility conditions for the Early Intervention Program. WRC looks into child’s developmental, social, and medical history. This information may come from outside sources or from in-home interviews, examinations and testing. There is no cost to you for any of the tests or other services that we provide during Intake. Below is a step-by-step overview of this process.

Step 1

Family members, physicians, schools, and/or hospitals contact the Intake Department at WRC to refer a baby or young child.

Step 2

You will complete the intake application with any records, including private evaluations and other pertinent medical records. You will be asked to complete and sign parent consent forms, which are essential to complete the process.

Step 3

You will be contacted to schedule evaluations that may take place at the home, school, and/or WRC. These include (1) family intake evaluation by an Intake Counselor, (2) developmental evaluation, and (3) other evaluations as needed (e.g. speech/language, medical, etc.).

Step 4

An eligibility team will meet to review your child’s records and evaluations. You are invited to be present at this meeting. Once a decision has been made, you will receive a letter informing you of your child’s eligibility status. If not eligible, the intake team will provide you with appropriate community resources. If you disagree with the eligibility decision, you have the right to appeal the decision.

Submitting An Application and Consent Forms

An application must be completed in order to assist WRC to determine eligibility for the California Early Start Program. Below you can find all the necessary forms required for WRC to initiate the evaluation process. The collection of the information on this application is required by the State of California, Department of Developmental Services. To begin the process:

Step 1

Complete the application as accurately as possible.

Step 2

Sign the consent forms for evaluation and services. The evaluation process cannot begin prior to receipt of your written consent.

Step 3

Fill-in, print out, sign, and submit the entire application and the consent forms to WRC’s Early Start Intake Department.

To submit your application, you may choose one of the following:

1. Scan the documents and send them as an email attachment to IntakeUnderAge3@westsiderc.org
2. Fax the documents to (310) 258-4059
3. Mail the documents to:

Westside Regional Center

Intake Under Age 3

5901 Green Valley Circle, Suite 320

Culver City, CA 90230

4. Provide all documents in person to the receptionist at Westside Regional Center (please follow social distancing protocols)

Need Help Filling Out Your Application?

Application questions can be answered by our culturally sensitive staff. You can also find more information about California’s Early Start Program online.

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