OAC Membership Form

My relationship to Autism

The Ontario Autism Coalition membership is made up of people on the spectrum, and those who live, work and play with them. Please select from the list below any and all skills which you may have. As a volunteer organization, we draw upon our members for help.

Please select the option(s) which best describe your occupation and/or skills:

Agriculture Arts, Entertainment, and Recreation Broadcasting College, University, and Adult Education Computer and Electronics Construction Finance and Insurance Forestry, Fishing and Hunting Government and Public Administration Health Care and Social Assistance Homemaker Hotel and Food Services Information Services and Data Processing Legal Services Manufacturing Military Mining Primary/Secondary (K-12) Education Publishing Real Estate, Rental and Leasing Religious Retail Scientific or Technical Services Software Telecommunications Transportation and Warehousing Utilities Wholesale Retired Unemployed

I am currently (please select all that apply)

Waitlisted Discharged Never Received Service Direct Service (DSO) Direct Funding (DFO)

Did you ever receive IBI?

Yes No

Did you receive any other therapies?

Yes No

Please specify which therapies you received

Are you currently employed?

Yes No

What is your approximate age?

10 or under 11-17 18-34 35-49 50-64 65+ Prefer not to say

Are you receiving any of the services listed below? (please tick all which apply)

Special Services at Home (SSAH) Ontario Disability Support Program (ODSP) Assistance for Children with Severe Disabilities (ACSD) Developmental Services Ontario (DSO)

Describe your personal connection to Autism

Do you have one or more children on the spectrum?

Yes No

Date of Birth

Day Month Year Date Picker Icon

Date of Birth

Day Month Year Date Picker Icon

Date of Birth

Day Month Year Date Picker Icon

Date of Birth

Child 1

Date of Birth

Child 2

Date of Birth

Child 3

My child is currently (please select all that apply)

Waitlisted Discharged Never Received Service Direct Service (DSO) Direct Funding (DFO)

Please select your regional Autism Intervention Program service provider

If applicable

Are any of your children currently in school?

Yes No

Please select your school board

As a non-profit advocacy organization comprised of volunteer members, we need your help, especially with the following key areas:

Event planning, fundraising, public and media relations, social media, special operations, stakeholder relations, and technology.

If you believe you could help with any of these, or if you have suggestions for other areas of concern we'd appreciate your feedback!

How would you like to help?

Would you consider becoming a Contributing Member? *

Yes! Not now I'd like more information

Thanks for asking for more information! Please complete your membership registration, then send an email with your query to:

info@ontarioautismcoalition.com

Make a contribution to Ontario Autism Coalition

Ontario Autism Coalition (OAC) is incorporated (Ontario Corporation #1845978), and is a registered non-profit organization. While gratefully received, OAC cannot issue tax receipts for contributions.

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