This form is intended to be completed by either a service provider, discharge staff, or the individual themself and is for use to refer individuals to the Ventura County Aging & Disability Resource Center (ADRC). The individual will be offered short-term service coordination and access to the following services through the Independent Living Resource Center: advocacy, benefits counseling, housing assistance, access to assistive technology, private registry of caregivers, and independent living skills training.

Complete this referral form below and click the "Submit ADRC Referral Form" button when finished. Or you may print out this page to fill out by hand and send it to Kelly Kivlahan at ILRC by email kkivlahan@ilrc-trico.org or fax (805) 650-9278. An intake will be scheduled within 1-2 days of receipt. Please allow 5 days advance notice prior to an individual's discharge from a medical facility. Individuals referred must have a point of contact that will participate in the intake process and service coordination if they are unable to do so themselves.