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Caregiver Mediated Program - Eligibility Form

Have a diagnosis of Autism Spectrum Disorder, and not yet registered with the Ontario Autism Program?Contact Access OAP at 1-833-425-2445 or visit聽
Require technical support or having trouble registering?Contact UU直播 at 1-877-996-1599

General Information

Child Name(Required)
MM slash DD slash YYYY
Primary Contact Name(Required)
Address(Required)

Eligibility

To confirm eligibility for the program:
I received an invitation from the Ontario Autism Program for Caregiver Mediated Services(Required)
My child is registered with the Ontario Autism Program(Required)
My child is under 48 months old (kindly note, your child must be under 48 months at the start of service)(Required)
I have not participated in Caregiver Mediated Early Years Services in the current fiscal year (April 1st to March 31st)(Required)

Families cannot receive Entry to School, or Core Clinical Services AND Caregiver Mediated Services at the same time. For further details and scenarios that may impact eligibility, click here.

Is your child currently enrolled in the Entry to School Program?(Required)
Read more about the
Is you child currently receiving Core Clinical Services?(Required)
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