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South Central Los Angeles Regional Center


SCLARCSouth Central Los Angeles

Regional Center

for Persons with Developmental Disabilities, Inc.

Early Start Intake Unit Referral Form

Hello, SCLARC provides services within the Los Angeles County health districts of Compton, San Antonio, South, Southeast, and Southwest LA.

Continue below and select your zip code to begin the online application.

If you do not see your zip code listed, your zip code is not served by SCLARC. Please visit to find out which Regional Center serves your area.

This online form is the fastest and most convenient way to apply for services at SCLARC. Alternatively, applications and referrals can be submitted by email, fax, or phone. To submit this application via email or fax instead, click here to download, then print, fill out, and return via email to or via fax at (213) 947-4115. To submit a referral by phone please call (213) 744-7068, or (213) 744-8807, or (213) 744-8809.

By completing this form you agree to be contacted by phone call, text, and/or email by a Regional Center representative during business hours.

Please complete this referral form to be considered to receive Regional Center services for children 0 to 2 years and 10.5 months of age only.

For individuals over 3 years of age please use the Lanterman Intake Application by clicking here


As of today, how old is the child?

Child's Information

Full Name of applicant

Date of Birth

Date Picker

Information of adult responsible for child

Are you (the person filling out this application) the child's primary caregiver?

Your Name

Caregiver's Full Name

Caregiver's Address

Primary phone type

Secondary phone type

Is there a DCFS Case (Department of Children and Family Services) or Worker assigned to the applicant?

Please provide all available information.

Reason for Applying

Has the child previously applied for or received services from South Central Los Angeles Regional Center or another Regional Center?

What regional center?


Please select below documents to attach and submit with this referral. Documents may be in format PDF, DOCX, or JPG(picture). Note, medical records and other documents may be necessary to process this referral, referrals without documents attached may be delayed. If no documents are to be submitted at this time, click Next to continue to next page to sign and submit this application.

Medical Records (File size limit is 250MB)

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Other Document 1 (File size limit is 250MB)

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Other Document 2 (File size limit is 250MB)

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Other Document 3 (File size limit is 250MB)

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Other Document 4 (File size limit is 250MB)

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By submitting this application I certify all information is true and correct to the best of my knowledge. If completing on behalf of another person, I certify I am authorized to represent that individual. I agree to electronically sign this application and to create a legally binding document.

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