Request to pay form 2026

1. Click ‘Get Form’ to open the request to pay form in the editor.
2. Begin by filling out Section 1, which requires your personal information as the parent or guardian. Include your last name, first name, middle name, home and work phone numbers, address, city/town, and postal code.
3. Proceed to Section 2 to provide details about your child. Fill in their last name, first name, middle name, date of birth, and indicate if they are in the care of the ministry.
4. In Part A, authorize payment for autism intervention services. Enter the service provider's name and agency (if applicable), their address and phone number. Specify the type of service(s) provided along with start and end dates.
5. Calculate the total amount by entering the fee per hour/day and multiplying it by the expected hours/months of service.
6. If applicable, complete Part B for additional expenses like travel or training. Provide detailed descriptions and costs for each item.
7. Finally, sign and date the form before mailing or faxing it to the Autism Funding Unit.

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