Volunteer Application Form

Program Applying For:

Phone Number:

Email:

Name:

Age:

Home Address
Street:

Province:

Postal:

Country:

Why do you want to volunteer with autistic people?

Do you have experience that you feel is related to the types of programs offered at the Autism Centre?

Is there anything you would like to add?

Please enter the 4 letters you see in the image on the right.

The Provincial Autism Centre
1456 Brenton Street
Halifax, N.S. B3J 2K7

Telephone: 902-446-4995
Toll free in Nova Scotia: 1-877-544-4495

Open: Monday to Friday 8:30am to 4:30pm