Online Coding and Social Skills Free Pilot Interest Form
Coding Autism is currently looking for students on the autism spectrum ages 13-24 to sign up for our online coding and social skills pilot. If you are under 18 years of age, please have your parent or guardian fill out the interest form. Pilot will begin in October and last 4-6weeks.
Are you 18 years of age or older?
If you answered NO above, a parent or guardian needs to fill out the rest of the form. Parent or Guardian's Full Name.
Student's First Name
Student's Last name
Age Group of Student
16-18 years old
19-24 years old
Can you (student) communicate verbally?
Which program are you interested in? You may check more than one.
Online Coding Program
Online Coding & Social Skills Program
Girls Online Coding & Social Skills Program
Online Social Skills Program
Girls Only Social Skills Program
Have you (student) taken any other coding programs?
For our online program, we will be using either Google Hangouts or Zoom. Do you (student) have experience using these video conference tools?
I have used Google Hangouts.
I have used Zoom.
I have experience using both Google Hangouts and Zoom.
I DO NOT have experience using either Google Hangouts or Zoom.
Can you commit to attending the program between 1-1.5hrs/week live online for approximately 4-6 weeks? Course will be held between 3-7pm Pacific Time during the weekday.
Which times work best for you? Check all that work for you.
3:00-4:30pm Pacific Time
3:30-5:00pm Pacific Time
4:00-5:30pm Pacific Time
4:30-6:00pm Pacific Time
5:00-6:30pm Pacific Time
5:30-7:00pm Pacific Time
6:00-7:30pm Pacific Time
Location (City, State)
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