Request for CARD Services
Adults, parents, and family members:  If you have not contacted CARD before please indicate your need for an intake in the appropriate place below.

Agencies/Businesses/Professionals who are requesting training: Training is provided by CARD on topics of importance to those involved with individuals with autism and other related disabilities. The focus of training is on awareness and skill development.

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Date of request *
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YYYY
Your role? *
Are you registered with FAU CARD? *
What kind of services do you require? *
Reminder: If you are an individual, parent, or caregiver that has NOT contacted CARD before, please choose intake.
Do you have a documented diagnosis of autism or a related disability?
Contact person *
Phone *
Age of Individual *
Type N/A if not applicable
If applicable, what grade are you, or your child, in? *
Address (Street) *
Address (City) *
Address (State) *
Address (Zip Code) *
County (if you live outside our service region, please use this link to locate your CARD Center: http://florida-card.org/) *
Email *
I am requesting information or training in the following areas:
For parents and caregivers, please indicate areas of interest
What is your preferred language for communication?
Any other relevant information *
Please tell us how we can best assist you.
Note for Providers:  If you are making a request for a family, please be sure to confirm that the family isn't already registered with FAU CARD and has provided consent for you to share their confidential information with us.  Thank you.
An FAU CARD Clinician will contact you to follow-up on your request.
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