Advocacy In Action Application 9-Week Program Advocacy In Action Application Program SelectionPlease select the program that works best for your schedule. Please note: This program is currently available for residents of British Columbia (BC) only. If you have any questions about eligibility, feel free to reach out before applying.Program Options: Winter 2025 (January 20-March 21) Spring 2025 (April 14-June 13) Fall 2025 (September 15-November 14)The program includes a scheduled weekly 1:1 call. Please select all times you are available so I can assign a consistent slot for the duration of the program. Meetings last 1 hour. Call times are listed in PST. Tuesday: 9:00–10:00 AM Tuesday: 10:30–11:30 AM Tuesday: 12:30–1:30 PM Tuesday: 2:00–3:00 PM Thursday: 9:00–10:00 AM Thursday: 10:30–11:30 AM Thursday: 12:30–1:30 PM Thursday: 2:00–3:00 PMParent /Guardian Contact InformationPlease have the primary parent or guardian complete this form. If there is a second parent or guardian who will be involved, their details can be added later during the intake process. This ensures we focus on the primary contact for the application.First NameLast NameEmailPhone/MobileChild InformationFirst NameLast NameAge– Select –Under 556789101112131415161718+Current Grade– Select –KindergardenGrade 1Grade 2Grade 3Grade 4Grade 5Grade 6Grade 7Grade 8Grade 9Grade 10Grade 11Grade 12Not Yet School AgeSchool DistrictSchool NameDoes your child currently have an Individual Education Plan (IEP)? Yes NoDoes your child have a formal diagnosis or diagnoses? Select all that apply. Autism ADHD Specific Learning Disability – Reading Specific Learning Disability – Writing Specific Learning Disability – Math Giftedness Developmental Coordination Disorder (DCD) Obsessive-Compulsive Disorder (OCD) Oppositional Defiance Disorder (ODD) Intellectual Disability Tourette Syndrome or Tic Disorder Anxiety Depression Other No Formal DiagnosesPreviousNextAdvocacy Goals & School ContextWhat are your primary advocacy goals for your child?What challenges are you currently facing in advocating for your child?What current supports or accommodations are in place at school, if any?Are there any professionals actively supporting or advocating for your child in the school setting? If so, please list their roles and scope of work.Anything else you’d like to share? (Optional)Payment MethodYou can choose to pay for the program using Autism Funding Unit (AFU) funds or through direct payment. If you’re using AFU, please ensure your child is registered and that funding is available before applying. How would you like to pay for the program? I will pay directly (one-time or split payments) I will use Autism Funding Unit (AFU) funding I have read and agree to the Terms and Conditions and Privacy Policy Previous Submit Form
