Autism Nova Scotia

Name *

First

Last

Email *

Phone

Which region do you live in? *

Central Region (Halifax to Sheet Harbour)
Northern Region (Cumberland County, Pictou County, Truro)
Tri-County (Western) Region (Shelburne, Yarmouth, Clare, Digby)
Annapolis Valley Region (Annapolis Royal to Windsor)
South Shore Region (Barrington Passage to St. Margaret’s Bay)
Strait Area Region (Antigonish, Port Hawkesbury, St. Peter’s, Cheticamp)
Eastern Shore Region (Canso, Sherbrooke)
Cape Breton Region (Sydney)
Prefer not to say

I identify as (please include all that apply): *

In a few sentences, please briefly describe your reasons for wanting to volunteer on the advisory committee. *

What changes would you like to see in Nova Scotia for individuals who have autism/who are Autistic? *

Please describe how your lived experience, education, community involvement, work or other experiences may be helpful to the committee. *

Most of our meetings will be virtual, but we may have some in person, hybrid meetings. Do you require any accommodations to participate in the committee. (e.g. sign language interpreter, large print, scent free environment, quiet space) *

Yes
No

If yes, please identify the type(s) of accommodations below.

File Upload

Click or drag files to this area to upload. You can upload up to 2 files.

If you have a resume or other supporting document please feel welcome to attach it, though resumes are not strictly necessary for this application.

Application – Provincial Autism Action Plan Community Advisory Committee