Autism Nova Scotia

Name *

First

Last

Email *

Phone

Which region do you live in? *

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

What is your age range? *

In the box below, please tell us why you feel your experience and background makes you a good fit for one of the Working Groups. *

Please select one or more of the Working Group topics that interest you, or select no preference. *

The Working Group meetings will be virtual. Do you require any accommodations to participate? (e.g. sign language interpreter, etc.) *

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.

Working Groups Application