Community Schools Initiative (CSI) Provider Referral Form


 

This provider referral form is for providers from the fifteen Community School Initiative (CSI) school districts, to refer families that seek additional support from 211LA CSI Program. The 211LA CSI Program has Outreach Coordinators designated at one of the fifteen school districts. We do ask that you have permission from the parent prior to filling out this referral form for privacy purposes.  

 

Please allow up to 3 business days once the form is submitted and one of our CSI Outreach Coordinators will contact the parent to schedule an appointment. The appointment will help the family find resources that they need and support them through the process and/or paperwork if required by any given resource.


If you are from an outside school district, please utilize our 211la.org website or you can email the CSI Team for assistance at csi@211la.org . If you are from LAUSD, please contact communityschools@lausd.net.

 

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

The client is aware of this referral and has given consent for a 211 LA Outreach Coordinator to contact them using the information provided.

CLIENT INFORMATION

Preferred Contact Method
Preferred Contact Time

REFERRER INFORMATION

CASE INFORMATION

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