Skip survey header

Individual School-Based Consultation, Individual Home, Community-Based Consultation Registration

Applicant Information

What option offered through the HANDS in AutismĀ® Center would you like more information about? *This question is required.
Primary Contact Information *This question is required.*Most of our communication with you will occur via e-mail, postal delivery service, or phone. As a result, please ensure that you can be contacted via the primary contact information you have provided.
Ethnic Information:
Role (select all that apply):
Medical Professional: What is your role?
School Personnel: What is your role?
Family Member: What is your role?
Community Provider: What is your role?
Primary disability categories or medical considerations for the individual(s) you support and the relevant diagnoses or considerations for all that are applicable:
How did you hear about HANDS?
Optional: Would you want to join HANDS email list(s) to receive event updates, newsletters, as well as practical pointers via email? Check any/all subscriptions you would like to join.