We Want to Share Your Story!
Please answer the questions below. Your answers will in turn be a part of our Community Outreach program, and not only help our mission, but raise awareness in our community. If you have any questions after the questionnaire, please contact our Executive Director, Katy Grant, by email at
director@autismevansville.org
, or by calling (812) 202-9405. Thank you for your time!
* Required
Email address
*
Your email
What is your Name?
*
Your answer
Please list the full names of your children along with their ages.
*
Your answer
Which of your children have been diagnosed with ASD?
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Your answer
What age was your child/children diagnosed? Please list first name along with age.
*
Your answer
Does your child/children receive any services for their diagnosis?
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Yes
No
Other:
If yes, who provides services for your child/children? Please list the service associated with each service provider.
Your answer
How has the diagnosis affected you and your family?
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Your answer
What are some of your family's experiences realated to your child's diagnosis?
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Your answer
How were you introduced to Autism Evansville?
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Your answer
Have you utilized any of the following Autism Evansville programs? Please check all that apply.
*
Voucher Program
Family Fun Night
Parent Support Group
Annual Walk & 5K
Volunteer for Community Outreach or above programs
Required
How would you explain to someone your experience with Autism Evansville?
*
Your answer
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