Government of Ontario: Ministry of Community and Social Services

Ontario Disability Support Program
Employment Supports

Employment Support Funding Agreement

This is an agreement between

and the Ministry of Community and Social Services.

This Employment Supports Funding Agreement (ESFA) includes information about your:

You and the Employment Supports Specialist must sign this Employment Supports Funding Agreement (ESFA) before you begin to receive services from a service provider.

Competitive Employment Plan

My competitive employment plan will include the following steps:

Rights

Responsibilities

Terms and Conditions

This Employment Supports Funding Agreement will apply for theduration of my participation in ODSP Employment Supports.

I understand my rights and responsibilities and agree to the terms and conditions of this agreement.

Signature of Applicant *


Date (yyyy/mm/dd)


Signature of ODSP Employment Supports Specialist


Date (yyyy/mm/dd)


* In situations where the applicant is unable to provide consent in writing, by reason of physical or mental disability, the consent of the trustee, legal guardian or, if there is no legal guardian, the next of kin (with the applicant's verbal consent), will suffice.

Notice with Respect to the Collection of Personal Information

(Freedom of Information and Protection of Privacy Act)

The information is collected under the legal authority of the Ontario Disability Support Program Act, S. O. 1997, c.25, Schedule B, sections 32 and 33 for the purpose of providing employment supports to enable persons with disabilities to obtain and maintain employment. For more information

at in your local Ontario Disability Support Program Office.

 

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© Queen's Printer for Ontario, 2006