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Neurodiversity Connections Interest Form
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Email
*
Your email
Name: First and Last
*
Your answer
Preferred Pronouns
*
Your answer
Today's Date:
*
MM
/
DD
/
YYYY
What class year are you?
*
First Year
Sophomore
Junior
Senior
Graduate Student
Transfer
Hometown/State/Country
Your answer
Are you interested in participating in the weekly
Neurodiversity Connections drop-ins
on Thursdays from 3 to 4pm?
Yes
No
Maybe
Other:
Clear selection
If so, do you have topics of interest you'd like to discuss at our weekly
Neurodiversity Connections drop-ins
?
Your answer
Would you like to participate in a
student-led
Neurodiversity Social Club
on campus?
*
Yes, I'd like to participate
No, I'm not interested in participating
Other:
If you are interested in participating in the
student-led
Neurodiversity Social Club
, what days and times are you available for activities?
Your answer
What are some ways you'd like to connect with other students? (Check all that apply)
*
Board or card games
Video games
Sports
Movies / movie night?
Walks / hikes
Coffee/Food outings
Other:
Required
Is there anything else you'd like to share about yourself and/or your interest in neurodiversity?
Your answer
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