Community Schools Initiative (CSI) Self Referral Form


 

As part of the Los Angeles County Community Schools Initiative Program (CSI), 211 LA has Outreach Coordinators available to support families in need of immediate resources (food, shelter, utility assistance, and much more) who have a child enrolled in one of the fifteen school districts. This form is to request  assistance from the 211LA CSI Outreach team, who will contact you using the information that you provide.

Please allow up to 3 business days for a CSI Outreach Coordinator to contact you and schedule an appointment with you once your form is submitted. If you are in need of immediate assistance or are in crisis, you can get help right away by chatting online or dialing 2-1-1.


If you are from a school district that is outside of the Community School Initiative school districts, please contact your school district for information regarding support for you and your family and continue to utilize our 211LA webpage for local resources. If you are from LAUSD, please contact communityschools@lausd.net

 

If this is a life or death emergency, please 9-1-1.

By submitting this form, I consent to have a 211 LA Outreach Coordinator contact me using the information provided.

PLEASE COMPLETE THE FOLLOWING FIELDS FOR THE CLIENT

Preferred Contact Method
Preferred Contact Time

PLEASE COMPLETE THE FOLLOWING FIELDS FOR YOUR HOUSEHOLD DEMOGRAPHICS

Pregnant Women in the household?
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