Fillable AUTHORIZATION FOR REFERRAL TO WESTSIDE FAMILY RESOURCE AND (Westside Regional Center)

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AUTHORIZATION FOR REFERRAL TO WESTSIDE FAMILY RESOURCE AND (Westside Regional Center)

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Committed To Providing Support And Services To People With Developmental Disabilities
5901 Green Valley Circle, Suite 320, Culver City, CA 90230-6953 (310)258-4000 FAX: (310)649-1024 www.westsiderc.org
AUTHORIZATION FOR REFERRAL TO
WESTSIDE FAMILY RESOURCE AND EMPOWERMENT CENTER
As the parent/guardian of ______________________________, I hereby authorize Westside Regional
Center’s Intake Coordinator to refer me and my family to Westside Family Resource and Empowerment
Center (WFREC). WFREC is one of Early Start Family Resource Centers that provide parent to parent
support, outreach, information, and referral services to families of children with special needs and the
professionals who serve them.
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AUTHORIZATION FOR REFERRAL TO WESTSIDE FAMILY RESOURCE AND (Westside Regional Center)

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Completed 7 February 2021

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