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AAA Autism Info (2021-2023)
Survey about Children with Autism in Lebanon
Parent's Name or Phone Nbr *
Mother/Father (Filling this Form) *
Parent's Job (Mother/Father Filling this Form) *
Parent's Education (Mother/Father Filling this Form) *
Required
Email *
Parents' Address *
Parents' Marital Status
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Child Living with Parents
Clear selection
Name of the Child (or Abbreviation)
Child's Gender *
Did your child attend an inclusive school previously *
Child' school *
Child' class (if Child attends a mainstream school) *
Name of the school/institution
Can your child read & write *
Child's Date of Birth (Month, Day, Year) *
MM
/
DD
/
YYYY
Age of the Child When you suspected Autism *
First Sign Why you suspected Autism *
Required
Child's age when you got an official Diagnosis (in months)
What level of your child's autism (Level 1 is mildest autism, Level 10 is very severe autism) *
Mild Autism
Severe Autism
Child's Hobbies *
Required
Is your Child Autonomous
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Is your child Verbal *
Does the child with autism have siblings *
Required
Who was the first to notice your child is different *
Required
Any Special Diet is your child following *
Required
Who gave you the official diagnosis *
Required
Does your child go to Specialists *
Required
Any other Medical Condition *
Required
Any Medication *
Required
What Tests/Exams have you done *
Required
What is the most challenging behavior of the Child *
Required
Have you ever attended a parent support group *
Have you ever attended trainings for parents of children with autism *
What kind of training you would like to attend *
Are you a member of AAA *
Would you like to be an active member in Autism Advocacy *
What are your main fears for the future *
Preferred Language
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Suggestions
PLEASE FOLLOW AAA SOCIAL MEDIA PAGES !
https://www.facebook.com/AAA.AutismAwarenessAssociation
https://www.instagram.com/AAA_Autism_Awareness
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