Submit a Referral

Is Coordinated Family Support right for you?

Our services are tailored for individuals who meet all of the following:

  • Adults ages 18 and older with a developmental disability
  • Living at home with their family, not in a licensed residential facility
  • Active consumers of the North Los Angeles County Regional Center (NLACRC)
  • Residing within the San Fernando, Santa Clarita, or Antelope Valley service areas
  • Authorized for Service Code 076 through a Regional Center Purchase of Service
A parent, a Regional Center Service Coordinator, and a coach review an Individual Program Plan across a table.

For families and caregivers

  1. Reach out to usFill out the form below or call (818) 253-9040. We will answer your questions and talk through whether CFS is the right fit for your household.
  2. Talk to your Service CoordinatorRequest Coordinated Family Support, Service Code 076, with Empower Life Skills, LLC. Your coordinator handles the authorization.
  3. We come to youOnce the authorization clears, our lead coordinator visits you at home to listen, learn, and begin building your personalized plan.

For Regional Center Service Coordinators

  1. Call or email to start a referralReach us at (818) 253-9040 or admin@empowerlifeskills.org to begin. We'll walk you through our secure process for exchanging referral documents — we do not accept IPP, POS, or consumer records as email attachments.
  2. Language matchingWe assign a coordinator fluent in the family’s primary language: English, Spanish, Tagalog, or Armenian.
  3. Contact within 2 business daysWe reach the family to schedule the in-home assessment, then keep you updated with clear progress reports.

Start the conversation

Tell us how to reach you.

Fields marked with an asterisk are required. We handle the details of your loved one's care by phone, not through this form — this keeps your family's information private and secure.

How this form works

This form collects only your own contact information. We do not ask for your loved one's name, date of birth, UCI number, or any details about their needs online. Once we have a way to reach you, we will gather the rest securely over the phone or during an in-home visit.

I am a *

All information submitted here is your own contact information only. We do not collect details about your loved one through this form — we'll gather that securely once we connect by phone.

Ready to talk about your family?

Call us at (818) 253-9040 or send a message. We respond within one business day, and referrals get an initial family contact within two.

Submit a Referral Contact Us