Bursary Application Form

To Apply

Please complete the Bursary Application Form below. For more information on the application process and eligibility criteria please contact us.

Application Deadline: February 21, 2025.

"*" indicates required fields

Child's Full Name*

Date of Birth

Diagnosis*

By Whom

When

Parent's Names*

Street Address*

City*

Postal Code

Email Address*

Phone Number*

Describe your child’s greatest needs to be addressed by ABA.*

Has your child previously received ABA and if so, from whom, when?

Are you committed to participating in an IBI program for a minimum of 20 hours per week?

Yes

No

Are you committed to a minimum of one year of IBI programming?

Yes

No

Disclosure of Access to Other Funding Sources

Ontario Autism Program

Yes

No

Private Insurance for IBI

Yes

No

Other Funding for IBI

8370