BHSDP Enrollment System
Multi-step eligibility & support application

Personal information

Step 1 of 6 — Basic details
First name
Last name
Date of birth
Email address
Phone number
🇨🇦
🇨🇦Canada+1
🇺🇸USA+1
🇬🇧UK+44
🇦🇺Australia+61
🇩🇪Germany+49
🇫🇷France+33
🇮🇳India+91
🇲🇽Mexico+52
Preferred language
Gender

Address & transportation

Step 2 of 6 — Location details
Street address
City
Province / State
Postal / ZIP code
Country
Primary transportation method
Housing situation

Health & disability

Step 3 of 6 — Medical background
Do you have any diagnosed medical conditions?
Do you have a physical or cognitive disability?
Do you use any assistive devices?

Financial & employment

Step 4 of 6 — Income & support status
Current employment status
Annual household income range
Do you currently receive any government assistance?

Emergency contact

Step 5 of 6 — Who to contact in an emergency
Contact first name
Contact last name
Relationship to you
Emergency contact phone
🇨🇦
🇨🇦Canada+1
🇺🇸USA+1
🇬🇧UK+44
🇦🇺Australia+61
🇩🇪Germany+49
Does this contact live with you?
Are they aware they are listed as your emergency contact?

Program reason & consent

Step 6 of 6 — Why you're applying
Why do you need this program?
How did you hear about BHSDP?
Have you previously applied to this program?
I confirm all information provided is accurate and truthful.
I consent to BHSDP storing and processing my personal data for enrollment purposes.
I understand I may be contacted by a program coordinator to verify my application.
Step 1 of 6