ErinoakKids - Independent Living Program 2025 Registration

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Independent Living Program Application 2025

Please complete the application below. Once this application has been submitted, Andrea Cachia, Life Skills Coordinator will contact you to set up an interview. The deadline for submission is February 17, 2025.

Interviews will take place on Saturday, March 1 2025 at our Mississauga location at 1230 Central Pkwy W. in Mississauga between 9:00 a.m. and 4:00 p.m. The interview will be approximately one hour long.

If you have any questions, please contact Andrea Cachia at 905-855-2690 ext.2684

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What is the name of your ErinoakKids clinician?*

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Client First Name*

Client Last Name*

Date of Birth*

Client Email Address*

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Client Address*

City*

Province*

Postal Code*

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Parent/Guardian Name*

Parent/Guardian Email Address*

Parent/Guardian Daytime Contact Number*

Parent/Guardian Evening Contact Number*

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How did you find out about the Independent Living Program?*

What high school did you attend?*

What grade are you currently in?*

Are you planning to attend college or university?*

What is the area of interest for your future studies?*

Consent

I consent

This form is being submitted with the knowledge and consent of named parents/legal guardians. ErinoakKids will always treat your personal details with the utmost care and will not share or sell your personal information. You may unsubscribe from receiving communications from ErinoakKids at any time. We are committed to keeping your information safe and confidential. We follow the rules set out in law about collecting, using and disclosing your personal information. For more information, please review our privacy policies publicly posted at https://www.erinoakkids.ca/privacy.