HTAC Continuation of Services Request

1

What is the name of the child or youth currently receiving support?* This field is required.To help us link this to the original request, please use the name as it appears in our records.

First Name

Last Name

2

What is the name of the person completing this request?* This field is required.

First Name

Last Name

4

Which category of support are you requesting to continue?* This field is required.

Continuation of extracurriculars

Tutoring

Therapeutic - therapy, diagnostic testing, second opinions on meds

Post-secondary Educational Support

5

Please provide a brief update on how the initial support has helped the child or youth so far.* This field is required.(e.g., "The tutoring has improved their math grade from a D to a B.")

6

Why is a continuation of this specific service necessary at this time?* This field is required.Explain the ongoing goal or what might happen if this support is discontinued.

7

What is the specific amount or timeframe you are requesting for this continuation?(e.g., "An additional 3 months of tutoring" or "$150 for ongoing therapy co-pays.")

8

Please upload any updated invoices, quotes, or progress reports related to this request.This helps our team process the extension more quickly.

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