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Please Fill Out The Following Form
Other names at your address who wish to join, if any:
Postal Code (required):
Email Address (required):
If you are joining because you have a child or other family member who has autism, what is that person’s name?
What is that person’s status with respect to the
On the waitlist
In the program
In the program but has turned six
Aged out without receiving service
Aged out but
How old was that person when diagnosed?
How long was that person on the waitlist for
How old is that person now?
Please upload a picture of the child you have told us about. Like the previous optional questions, this step is your choice, but it will help us show that real children are affected by government policy. Click Browse to locate your picture file:
By checking this box you indicate that you have granted permission to display this picture on our website and in presentations, and that you have read and agree to the
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