Fillable AUTORIZACIN PARA REFERIR FAMILIAS AL CENTRO DE RECURSOS (Westside Regional Center)

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AUTORIZACIN PARA REFERIR FAMILIAS AL CENTRO DE RECURSOS (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
AUTORIZACIÓN PARA REFERIR FAMILIAS
AL CENTRO DE RECURSOS Y FORTALEZA PARA FAMILIAS DE WESTSIDE
Como padre/guardián de _____________________________, Autorizo al coordinador de Westside
Regional Center que nos refiera a mi y a mi familia al centro de recursos y fortaleza de Westside
(WFREC). WFREC provee apoyo de padres a padres, servicios de divulgación de información y
referencias a familias de niños con discapacidades y a los profesionales que los atienden.
__________________________________________________________________________
Nombre y Apellido
__________________________________ ________________________________
Firma Fecha
__________________________________ ________________________________
Número de Teléfon E-Mail
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AUTORIZACIN PARA REFERIR FAMILIAS AL CENTRO DE RECURSOS (Westside Regional Center)

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Completed 7 February 2021

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