About You – Role Identification

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Email *

Record my email address with my response

1. Your Name (Optional):

2. Non-Verbal Individual’s Age *

3.Primary Communication Style (e.g., gestures, PECS, AAC): *

4.Diagnosis or Known Condition

5.Current Living Environment: *

At Home

Assisted Living

Residential school

Other:

6.Please indicate your role in relation to the non-verbal individual(s) referenced in this survey. You may select all that apply. This information is used solely to understand the context of your responses and will be kept confidential in accordance with U.S. federal and state data protection laws.

I am a non-verbal individual completing this form on my own behalf (self-reporting).

Parent or biological/adoptive guardian.

Court-appointed legal guardian or authorized representative.

Primary caregiver (e.g., family member, in-home aide, or support worker).

Licensed healthcare or therapeutic professional (e.g., a Doctor, speech-language pathologist, psychologist, behavioral therapist).

Educator, teacher, mentor, or academic support staff.

Friend or peer with direct knowledge and regular interaction with a non-verbal individual

Required

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