Welcome to Generation Alpha
Thank you for reaching out. This short form helps us get to know your family before we meet — so we can walk in already understanding what matters most. Takes about 10 minutes. Skip anything you're not ready for.
Your name (caregiver/parent)
*
First Name
Last Name
Your relationship to the person we're planning for
Best phone number to reach you
Please enter a valid phone number.
Format: (000) 000-0000.
Your email address
*
example@example.com
City / area you live in
How did you hear about us?
About the Person We're Planning For
Their first and last name or nickname
Age and date of birth
Primary diagnosis or diagnoses
Describe them in three words
What do they absolutely LOVE? What lights them up?
What is most challenging for them right now?
Current Services & Supports
Which Regional Center are you connected to?
Name of your Regional Center service coordinator (if known)
What services is the Regional Center currently providing?
Are you enrolled in the Self Determination Program (SDP)?
Please Select
Yes — already enrolled
We've applied and are waiting
Interested but haven't applied
Not sure what this is
Not applicable
Is this person receiving In Home Support Services?
Please Select
Yes
No
Applied and waiting
Not sure what this is
Does this person have an active Individual Education Plan (IEP)?
Please Select
Yes — currently active
Yes — transitioning out
No — they have a 504 instead
No — not in school
Not sure
Is this person receiving SSI or Medi-Cal?
Please Select
Both SSI and Medi-Cal
Medi-Cal only
SSI only
Neither
Not sure
Upload any documents you already have (optional)
Browse Files
Drag and drop files here
Choose a file
IPP, IEP, IHSS action notice, benefit letters — anything helpful. You can upload multiple files.
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What Brings You to US?:
What's happening right now that made you reach out?
What is the single most pressing thing you need help with?
What would a successful next 6 months look like for your family?
Are you interested in special needs financial planning?
Please Select
Yes — this is a priority
Maybe — I'd like to learn more
Not right now
We already have a plan in place
Are you looking for help finding social activities or camps?
Please Select
Yes — this is a big need
Somewhat — open to ideas
Not right now
We already have good connections
Anything else you want us to know?
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