Application and Procedure

Thank you for your interest in our services! Clients are accepted by application only.

To apply for our services:

  1. Download and fill out an application based on the service(s) you are interested in. (See links below)
  2. Apply online. For online youth applications, a teacher report form is required. 
  3. Drop off, fax in, or mail in your application to our address: 

    Community Clinic, ED2-155
    1250 Bellflower Blvd, 
    Long Beach CA, 90840
  4. Once received, Clinic staff will call to notify you that your application was received
  5. Clinic faculty will assess the information you provided to determine whether the criteria for the services offered are met.
  6. You will be contacted a second time, after the revision process is complete, to inform you of the status of your application. 
  7. If you are confirmed for our services or placed on the wait-list, our Clinic staff will remain in contact with you to answer any of your questions and to provide you with parking, receive payment, and further instructions.

Please note:

  • If you need any assistance, please feel free to call the Clinic office at (562) 985-4991.
  • Admittance is based on a first-come, first-served basis and on the level of need.
  • To maintain your confidentiality, we suggest you mail or deliver the application in person, rather than sending it via e-mail.
  • Depending on the services requested and the date your application was received, there may be a waiting period.
  • The primary purpose of the Clinic is to provide a training site for graduate students enrolled in various practicum courses. Although we would like to assist everyone who requests our services, we are not always able to do so.
  • In the case of a minor, only a parent or legal guardian of the child may submit an application for services.
  • If you would like to apply for a scholarship, please see our fee reduction guidelines:

***Fee Reduction Guidelines***


For Academic Interventions (ages 6-17), Psychoeducational Assessment (ages 6-17), or Youth Counseling (ages 17 and under):

Youth Application (PDF)

Teacher Report Form (ages 6-17), Required for all Online Applications 

Teacher Report Form (PDF) 

For the Early Childhood Assessment Clinic (ages 3-6):

Early Childhood Assessment Application (PDF)

For the Transition Planning Clinic (ages16-22):

Transition Planning Application (PDF)

For Adult, Family, Individual, or Couples Counseling (all ages):

Adult Application(updated) (PDF)
Couples Application (PDF)

Once a complete application is received and found appropriate for Clinic services, you will be contacted by a student assistant who will confirm your appointment and arrange your parking.

Aplicaciones en Español:

Para Tutoriá (edades 6-16), Evaluación Psicológicas (edades 6-16), o Consejería de Juventud (edades 17 y bajo):

Aplicacion de Jovenes (PDF)

Para Consejería de Adultos, Familiares, Individuales o de Parejas (todas edades):

Consejeria para Adultos (PDF)