Autism Ontario CommunityConnect Application Form

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Primary Contact
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Primary contact
 
 
 

The primary contact's name, email and phone will be used by Autism Ontario to communicate about the Service Listing and application

Primary Work Location

Work location information is included in public service provider listings

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Supplementary Work Location 1
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Supplementary Work Location 2
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Supplementary Work Location 3
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Supplementary Work Location 4
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Supplementary Work Location 5
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Supplementary Work Location 6
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Supplementary Work Location 7
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Supplementary Work Location 8
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Supplementary Work Location 9
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Add another work location
Service Listing Event Profile 1
 
Staff Person 1
Staff Person 2
Staff Person 3
Staff Person 4
Staff Person 5
Staff Person 6
Staff Person 7
Staff Person 8
Staff Person 9
Staff Person 10
Staff Person 11
Staff Person 12
Staff Person 13
Staff Person 14
Staff Person 15
Staff Person 16
Staff Person 17
Staff Person 18
Staff Person 19
Staff Person 20
Add another ABA certified staff person
Service Listing Event Profile 3
 
Staff Person 1
Staff Person 2
Staff Person 3
Staff Person 4
Staff Person 5
Staff Person 6
Staff Person 7
Staff Person 8
Staff Person 9
Staff Person 10
Staff Person 11
Staff Person 12
Staff Person 13
Staff Person 14
Staff Person 15
Staff Person 16
Staff Person 17
Staff Person 18
Staff Person 19
Staff Person 20

For each staff person who is a regulated professional, add a link to their listing on their College's site showing their status. If a URL directly to the record is not available, a link to the regulator's site is sufficient. For a camp, link to the camp's accreditation. Staff information is used by Autism Ontario for verification purposes and is not displayed to the public

Add another staff person who is a regulated professional
Service Listing Event Profile 2
 
Add another session

I certify that all of the information contained in my listing is true and I have the authority to add this listing to Autism Ontario. I understand that failure to comply with the above criteria may result in the removal of my listing

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Please note Autism Ontario reserves the right to refuse, suspend, or remove an applicant or previously approved member of Autism Ontario Listing Service