Submitting An Application

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.

• English Application
• Spanish Application

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. Upon submitting a completed application packet, an Early Start 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: intakeunderage3@westsiderc.org
• Fax: (310) 258-4059
• US Mail:

Need Help Filling Out Your Application?

Application questions can be answered by our culturally sensitive staff. Call Sonia Garcia at (310) 258-4120 or email her at SoniaG@WestsideRC.org.