Independent Facilitation
New Client Interest Form

Thank you for your interest in Guidelight Group services.

We look forward to connecting with you!

Please note that Guidelight Group's independent facilitation services are only available once a participant has completed the process of transitioning to SDP and is actively enrolled in the program. Please do not complete this form if you have not yet begun this process.

First name*

Last name*

Email*

Phone number*

Street address

City*

State/Region

Postal Code

I am a...*

Parent or family member

Self-advocate

Professional

Other

Service recipient information (if you are not the service recipient):

Service recipient name

Service recipient age

Service recipient email

Service recipient phone

Regional Center affiliation

Alta California

Central Valley

East Bay

Eastern Los Angeles

Far Northern

Golden Gate

Harbor

Inland

Kern

Lanterman

North Bay

North Los Angeles County

Orange County

Redwood Coast

San Andreas

San Diego

San Gabriel/Pomona

South Central

Tri-Counties

Westside

Valley Mountain

Please tell us a bit about the kind of support you are seeking. Indicate whether the SDP participant is already enrolled in SDP or where they are in the process of transitioning. Note that our independent facilitation services are only for individuals once they've transitioned into SDP.

We currently have considerable wait times for independent facilitation services. Do you want us to share your contact information with a graduate of our independent facilitator training program if there is someone who might be able to work with you now?*

Yes, please share my name and contact information with a graduate of Guidelight Group's independent facilitator training who might be able to work with me.

No, do not share my information.

How did you hear about Guidelight Group?*

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Month/Day/Year

Independent FacilitationNew Client Interest Form

Independent Facilitation
New Client Interest Form