Student Services Intake Form

Student Services Intake Form

Complete this form to request support services for neurodivergent students. Please provide all relevant information to help us match your child with the right resources.
Welcome to WMC Canadian Academy
Personalized Support for Neurodivergent Students

At WMC Canadian Academy, we understand that every child learns differently. As an OAP-Approved Service Provider, we offer personalized academic tutoring, individualized learning strategies, and access to BCBA and Behaviour Therapist support based on each student's needs.

Our goal is to help your child build confidence, develop academic skills, and achieve meaningful progress.

Online and in-person services are available across our Ontario service areas.

Want to learn more about us first?

Visit the WMC Canadian Academy Website

Ready to get started?

Please complete the registration form below. Our team will contact you to discuss your child's individual learning needs and recommend suitable support options.

We look forward to supporting your child's learning journey
Parent/Guardian Name(s)
Student's Full Name

First NameLast Name
Student's Grade
Diagnosis (if applicable)
Parent/Guardian Email Address
example@example.com
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Which services are you requesting?
Tutoring: Please describe the subjects or skills you would like support with.
ABA: Please describe your goals or areas of focus for ABA services.
Is the student OAP (Ontario Autism Program) approved or on the waiting list?
Additional information or special considerations
Should be Empty: