Siblings Together Application Form for Teens
The next Siblings Together group will begin Spring and Summer 2025.  This group will fill quickly. If you have any questions please free contact Rikia Ancar, LCMFT at rikia@starobincounseling.com or Caron Starobin at caron@starobincounseling.com.  
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Email *
Participant's Name (Non-Autistic Teen *
Participant's Preferred Pronouns *
Participant's Age/Grade *
Participant's School *
Please name and describe mental health and/or medical diagnoses of the Participant. If not applicable, please type, "N/A" *
Please identify current mental health providers providing care to the Participant. Identify the type of care (therapist, school counselor, psychiatrist). If not applicable, please type, "N/A" *
Sibling's Name (Autistic Child) *
Sibling's Preferred Pronouns
Sibling's Age/Grade *
Sibling's School *
Sibling's Diagnoses and age of diagnoses (please include all mental health and medical diagnoses). *
Parent/Guardian Name *
Parent/Guardian Email *
Parent/Guardian Phone Number *
Where do you live (City, State)?   *
What format would you prefer? *
Please briefly identify concerns/challenges you (if you are the teen or young adult) or your teen (if you're a parent) faces as a sibling of a child with Autism (e.g., explaining autism to friends and family, increased household responsibilities, feeling isolated). *
Do you give consent to add your email to the Starobin Counseling  email distribution list through Mailchimp to receive important updates about Siblings Together?
 *
A copy of your responses will be emailed to the address you provided.
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