2020 Symposium Fee Waiver Application
Thank you for your interest in the 4th Annual Southeast Adult Autism Symposium. The Symposium will be held virtually on Friday, July 24 and Saturday, July 25.
Registration waivers are made possible from scholarships from Tennessee Council on Developmental Disabilities and the Georgia Council on Developmental Disabilities. These waivers are meant to support individuals experiencing economic distress and cannot afford to pay the registration fee.
These organizations require us to collect demographic information for waiver recipients and we are required to have recipients fill out a satisfaction survey after the symposium. We have added the demographic questions to this form.
We will contact you after completing this form to confirm you are receiving a waiver and will register you for the symposium.
Enter first name of individual seeking waiver
(xxx) xxx-xxxx format
Select the option(s) that fit for person seeking waiver. I am a(an)....
Relative/caregiver of autistic individual
Professional who works with autistic individuals
What is the geographical area around where you live?
How would you describe your gender?
Prefer not to say
What is your race/culture/ethnicity? Please choose what best fits you.
White or Caucasian, alone
Black or African American, alone
American Indian or Alaska Native, alone
Native Hawaiian or Other Pacific Islander, alone
Two or more races
I will complete a satisfaction survey after I attend the symposium.
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This form was created inside of Chattanooga Autism Center.