Student Research Study
We are conducting general interviews to learn more about the Autism Spectrum Disorder (ASD) community.

Would you be available for a 15 minute discussion either via in-person, video chat, or phone call to assist our project?

Additionally, we are performing mobile application user testing, would you be interested in participating in that too?

Please let us know what time works for you, if interested. This will begin in August, 2018.

You can reach Brent Chase at or by phone at +1(410)440-2478. Thank you in advance for your time and consideration.
Sign in to Google to save your progress. Learn more
Are you okay with us contacting you in person, by phone, or video chat to discuss your successes and challenges of parenting or working with an individual with ASD or having ASD yourself? *
Name *
Email *
Phone Number
Would you be interested in user testing a mobile application that would be utilized by parents in the ASD community, that we are developing? *
What state are you based out of (Ex. for Maryland use MD, New York use NY, California use CA)? *
What is your role in the ASD community (parent, therapist, professional, etc.)?
What times are best to be contacted (time and days of the week)?
Clear form
Never submit passwords through Google Forms.
This form was created inside of Rochester Institute of Technology. Report Abuse