Required fields are marked with asterisks (*)

Access Program Application

To apply for the Town of Whitby Access Program, please ensure that all steps are completed. For further questions please contact 905.655.2893 or email subsidy@whitby.ca.

Step 1: Family Information
Step 2: Financial Information

Step 1: Family Information

Your application will be reviewed. You will be contacted regarding your eligibility for the program. If approved, your level of subsidization will be noted in your account in our registration system. Approval for an application form is valid for one year from the approval date.

Main Contact

First Name

Last or Single Name

Primary Phone Number

Secondary Phone Number

Date of Birth

Email Address

Street Number

Street Name

Unit Number (if applicable)

Town/City

Postal Code

Preferred Pronouns (she/her, he/him, they/them, etc.)

Do you have a spouse or partner living at the same address?

Yes

Do you have one or more dependents living at the same address?

Yes

Step 2: Financial Information

My family receives Government Social Assistance

Yes

Additional Questions or Concerns

Personal information collected on this form is collected under the authority of the Municipal Freedom of Information and Protection of Privacy Act and will be kept in the strictest of confidence. Questions regarding the collection of this information should be directed to the Town Clerk, 575 Rossland Road East, Whitby, ON L1N 2M8.

Form Builder

Access Program Application

Step 1: Family Information

Main Contact

Step 2: Financial Information