LDIS

Intake Request Form

Community Eligibility Status: Be between 15 – 30 years old, Be a Permanent Resident, Conventional Refugee or a Citizen, Be actively seeking employment, Face barriers to employment.

I, give my consent for Lead Disability Inclusive Society BC to release the information contained in this form to ESDC. I acknowledge that the information disclosed to ESDC will be administered by ESDC in accordance with the Privacy Act (R.S.C., 1985, c. P-21) and the Department of Employment and Social Development Act (S.C. 2005, c. 34). I acknowledge that I have a right to obtain access to that information from Canada under the Privacy Act (R.S.C., 1985, c. P[1]21) and the Department of Employment and Social Development Act (S.C. 2005, c. 34). This information will be used to confirm that I am eligible to participate in the YESS Program and to help determine appropriate services and supports during my participation in the project. This information will be provided to ESDC for the evaluation, research and accountability of the YESS Program. I may be contacted in the future by ESDC about my participation in the program.

I confirm that I have completed the form myself, to the best of my knowledge.

I, hereby declare that the information provided in this application is accurate and true to the best of my knowledge. I understand that providing false or misleading information may result in the rejection of my application or termination from the program.