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KAT6 Foundation Community Survey
Thank you for expressing interest in joining the KAT6 Foundation community. The KAT6 Foundation supports families and individuals diagnosed with KAT6 syndrome (caused by KAT6A and KAT6B variants) and advances research to develop treatments for KAT6 syndrome. 

In order to help share important research information, community events, and support services we ask you to fill out the brief survey below. We will not share this information with anyone outside our community. Having this basic information is vital to advancing our mission. View our privacy policy.

The KAT6 Foundation was founded in 2017. We are a small, organization that is entirely led by fellow KAT6 parents who volunteer their time. We hope you will join us in supporting our children and families.
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First Name
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Last name
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Mailing address 
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City
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Zip code
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United States
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Cell Phone Number
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What is your relationship to a diagnosed individual?
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parent/guardian
grandparent
sibling
extended family (cousin, aunt/uncle, etc)
teacher, therapist
researcher
other
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add "Other"
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Would you like to be included on the KAT6 Family Map? (The KAT6 Family map helps families connect to others living nearby.) 
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Yes
No
We are already on the map.
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add "Other"
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Please check the information you would like to include on the map. (If you wish to remain anonymous, simply check location information.)
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Last Name
First Name
Location Information: City, State/Provence, Country (from information listed above)
Do not include us on the map.
I am happy with the current information regarding my family on the map.
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add "Other"
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What types of communication are you interested in receiving from the Foundation?
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Research opportunities and scientific updates
Fundraising campaigns
Conference information
Social Events
Newsletters
KAT6A related information
KAT6B related information
All of it!
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add "Other"
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The Foundation can always use more volunteers! Would you be interested in lending your support to any of the following committees?
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Science and Research
Fundraising
Marketing and Communications
Patient Advocacy and Welcoming Committee
Grant Writing
I am unable to volunteer at this time.
Other
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add "Other"
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I consent to the KAT6 Foundation sharing images of myself and/or my family members taken at KAT6 Foundation-sponsored events, such as the annual conference and KATwalk. These images may be used in promotional and informational materials, including newsletters, social media, the Foundation's website, and email communications. (If you plan to participate in future events, please indicate your preference regarding this use.)
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Yes
No
Not applicable
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add "Other"
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Signature for photo consent (enter your full name)
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Would you like to schedule a call with us to discuss ways we can support your family or learn more about the work that the Foundation is doing? (We will reach out via the email provided to schedule a time to talk.)
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No
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add "Other"
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First Name
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Last name
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Mailing address 
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City
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State/Provence/Region
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Zip code
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United States
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Cell Phone Number
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What is your relationship to a diagnosed individual?
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Would you like to be included on the KAT6 Family Map? (The KAT6 Family map helps families connect to others living nearby.) 
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No responses yet for this question.
Please check the information you would like to include on the map. (If you wish to remain anonymous, simply check location information.)
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No responses yet for this question.
What types of communication are you interested in receiving from the Foundation?
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No responses yet for this question.
The Foundation can always use more volunteers! Would you be interested in lending your support to any of the following committees?
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No responses yet for this question.
I consent to the KAT6 Foundation sharing images of myself and/or my family members taken at KAT6 Foundation-sponsored events, such as the annual conference and KATwalk. These images may be used in promotional and informational materials, including newsletters, social media, the Foundation's website, and email communications. (If you plan to participate in future events, please indicate your preference regarding this use.)
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No responses yet for this question.
Signature for photo consent (enter your full name)
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No responses yet for this question.
Would you like to schedule a call with us to discuss ways we can support your family or learn more about the work that the Foundation is doing? (We will reach out via the email provided to schedule a time to talk.)
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No responses yet for this question.
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