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Financial assistance application
Client Name (First & Last)
Date of Birth
Parent/Guardian Name (First & Last)
Email
Phone Number
Are you currently working with a professional? If so, list here:
Please select reason for needing assistance
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Financial need
Disability
Other barrier:
Please select Service
Choose an option
By checking this box, I certify that I do not have insurance coverage or have access to other sources of funding (E.g., Ontario Autism Program Funding, Jennifer Ashleigh Foundation Grant).
I understand that this is a lottery scholarship. Not all who apply will be selected for financial assistance. Those who have been selected will be contacted.
Submit Application
Thank you for your application! Good luck!
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