Neurospicers On Air!: Interview Application
Welcome to the Neurospicers On Air: Interview Application!

In this form, you will fill out the needed information to become a speaker on our radio broadcast with Empower House. Please fill the form out to the best of your knowledge. Your answers help us understand you and help us decide whether you're a good fit for the show.

This series focuses on neurodivergent individuals' stories of overcoming barriers and obstacles to better themselves.

All participants will be able to practice the interview questions ahead of time. We will not record live, but the recording will be released later on the Empower House Radio station.
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Email *
First name of speaker applicant *
Last Name of speaker applicant *
Phone number of speaker applicant (in the format 123-456-7890) *
Other contact First Name

(This is someone else you want to help you with participating.)

If none, type "N/A"
 *
Other contact Last Name

(This is someone else you want to help you with participating.)

If none, type "N/A"
 *
Other contact: Relationship

(This is someone else you want to help you with participating.)

If your relationship isn't listed, please use the "Other" box option to specify.

If none, type "N/A" in the "Other" box.
 *
Other contact Email address

(This is someone else you want to help you with participating.)

If none, type "N/A"
 *
Other contact Phone number (in the format 123-456-7890)

(This is someone else you want to help you with participating.)

If none, type "N/A"
 *
Have you (speaker applicant) been to a Neurospicy SA's event before? *
Are you above the age of 18? (This is NOT a deciding factor. It helps us understand you better.) *
What mental conditions do you struggle with? (ex. autism, bipolar disorder, ocd, anxiety, etc.) Your answers remain private and are only seen by our director/organizer, Meredith Marks. However, you will be asked to share this information on the broadcast. *
Tell us about yourself. 

Examples of what you could talk about: What are some interesting facts about you? What hobbies do you have? Do you have any pets? What is/was your favorite school subject and why? 

Anything interesting about you! Feel free to add as much detail as you want.
 *
Tell us about a time when you overcame a barrier, limit, or obstacle that was very difficult and prevented you from improving yourself. 

*Try to put as much detail as you can into this story. It helps us understand the context, your actions and choices, and the impact it had on you.
 *
What makes you want to participate in the radio broadcast? *
Is there anything else you'd like to note that you think would be useful for your application? *
Today's Date (the date of submitting this form) *
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