Enroll in a Program

Complete the form below to begin the enrollment process. Our team will review your submission and reach out within 1–2 business days to guide you through next steps.

Enrollment Application

Please fill out all required fields. If you have questions, call us directly or visit our Contact page.

Participant Information

Participant Full Name *

Date of Birth *

Regional Center

Service Coordinator Name

Service Coordinator Phone

Contact / Guardian Information

Contact Name *

Relationship to Participant

Email Address *

Phone Number *

Program Selection

Program of Interest *

Funding Type

Transportation Needed?

Additional Information

Anything else we should know?

Fields marked * are required. By submitting this form you consent to being contacted by our team.

Need Help?

Our team is happy to walk you through the enrollment process over the phone. Don't hesitate to reach out.

Janin Balmaceda

Director of Day & Community Program Operations

909.626.2900 [email protected]

Johnny Winsser

General Manager

909.476.8576 [email protected]

Cynthia Maqueda

Director of Transportation Services

909.441.8783 [email protected]

Our Programs

LC Vocation Day Program
Claremont · San Gabriel · Pomona
Lifetime Day Program
Inland Regional Center · San Gabriel · Pomona
LCB Community Based
San Gabriel · Pomona
Road to Success
Inland Regional Center
Express Workforce Foundation
Supported Employment
Excel Transportation
All program areas

Learn more about each program →