*1.Please indicate your relationship to Westside Regional Center(Required.)

Individual receiving support

Family member of individual receiving support

Service Provider

Community Member

Regional Center Staff

2.Which of the following would you like WRC to consider for future resource development (check all that apply):

Specialized Living Options for Adolescents with unique medical and/or challenging service needs

Specialized Living Options for Adults with unique medical and/or challenging service needs

Specialized Employment and Day Services for Adults with unique medical and/or challenging service needs

Affordable Housing

Mental Health and/or Substance Abuse Services and Supports (when generic resources are not able to meet individual needs)

Early Intervention Services

Specialized Services for the aging population and aging caregivers (not covered by generic resources)

Specialized Respite Services for children and adults with unique medical and/or challenging service needs

Clinical/behavioral services

Other (please specify)

3.Please provide any additional comments you may have on service needs selected:

4.Are there any additional unmet service needs you would like WRC to consider for future resource development: