Regional Center Clients

Homies Inquiry Form for Regional Center Clients

For individuals seeking SLS services looking to live independently. Fill out the form below to see if you qualify.

Client's Full Name

Street Address

City

State

Zip Code

Birthdate

Current Living Arrangement

Regional Center Enrolled

Services Currently Received via Regional Center

Preferred Language (Client)

Primary Language at Home

Full Name of Person Inquiring on Behalf of Client

Relationship to Client

Inquirer's Email Address

Inquirer's Phone Number

How did you hear about Homies?

Other Notes

Contact information

Please reach out if you would like more information on the Homies program.

Los Angeles, California

(951) 291-8279