KS NEUROAFFIRMING COLLECTIVE
BC Children and Youth Disability Benefit
Family Information Form
This form helps your clinician prepare a strong clinical support letter for your child's Disability Benefit application. Please answer as completely as you can — there are no wrong answers.
⚠️ Information gathering deadline: Summer 2026. Eligibility review begins Fall/Winter 2026–27. Current Autism Funding continues until March 31, 2027.
Step 1 of 5
1
Child & Family Information
Child's Legal First Name *
Child's Legal Last Name *
Date of Birth *
Gender (as recorded)
Select...
Male
Female
Non-binary / gender diverse
Prefer not to say
Parent / Guardian Name *
Relationship to Child
Select...
Mother
Father
Legal Guardian
Other caregiver
Phone
Email *
City / Region (BC)
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