One to One Summer Support Worker Reimbursement Fund - Application


CHILD INFORMATION

Note: Only reports from qualified diagnosing health professionals will be accepted.

PARENT INFORMATION

Address
Province
Languages Spoken at Home

DOCUMENTATION

Proof Of Diagnosis
One file only.
30 MB limit.
Allowed types: pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.

TERMS OF SERVICE

Application Process

  1. Autism Ontario is now accepting applications for participation in the 2024 Summer One to One Fund for a minimum of 500 randomly selected families.
  2. Please complete your signed application and mail it with copy of diagnosis. (You will receive a letter acknowledging our receipt of your application.)
  3. Autism Ontario will notify all applying families whether they were randomly selected to receive funds by June 7, 2024. If you are selected, you will receive further instructions that you must follow to submit eligible receipts by no later than September 13, 2024, before reimbursement is made.  Once all required documentation has been received, reimbursement of up to $600 will occur within 30 business days.

Note
  1. Autism Ontario will provide reimbursement to a maximum of $600 per child/youth for fees incurred by their parent/guardian who retains the services of a one-to-one support worker (worker must be 18 or older) during July and August 2024 for their child/youth with ASD (ages 18 years old and younger).
  2. Cheques will not be issued in advance of Autism Ontario receiving all documents (proof of diagnosis, signed application and original receipt(s)).
  3. Membership in Autism Ontario is not required to access the Fund, as per Canada Revenue Agency guidelines. However, the child/youth for whom the funds are intended must have a diagnosis of an Autism Spectrum Disorder.

Release of Liability
I understand that no information will be released without my authorization. I will indemnify and save harmless Autism Society Ontario (operating as Autism Ontario) and each of their officers, directors, employees, volunteers and agents from and against any and all claims, actions or demands, including, without limitation, reasonable legal and accounting fees, alleging or resulting from my use of the family funding. I am aware that Autism Ontario neither supports nor endorses any one camp or program.

I am also aware that Autism Ontario does not endorse or train any individual for the purpose of working one on one with my child. (Autism Ontario complies with the Personal Health Information Protection and Electronic Document Act (PIPEDA). All information gathered is stored in a confidential manner.  To view Autism Ontario’s Privacy Policy, please visit www.autismontario.com.)

By signing I am acknowledging the release of liability above and I am certifying that the information provided in this application is true, correct and complete to the best of my ability.
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