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 https://accessoap.ca/
Require technical support or having trouble registering?Contact Child & Community Resources at 1-877-996-1599

General Information

Child Name(Required)

First Last

Child Date of Birth(Required)

Primary Contact Name(Required)

First Last

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Email(Required)

Eligibility

To confirm eligibility for the program:

I received an invitation from the Ontario Autism Program for Caregiver Mediated Services(Required)

Yes

No

My child is registered with the Ontario Autism Program(Required)

Yes

No

My child is under 48 months old (kindly note, your child must be under 48 months at the start of service)(Required)

Yes

No

Ontario Autism Program Registration Number(Required)

I have not participated in Caregiver Mediated Early Years Services in the current fiscal year (April 1st to March 31st)(Required)

Yes, I have

No, I have not

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

Is you child currently receiving Core Clinical Services?(Required)

Yes

No

NOTE: After entering all required information you must click the submit button below. Those eligible will be redirected to the Registration Form, which must be completed to finalize your registration. If you are ineligible, you will be contacted by a Child & Community Resources representative.