NITW Database Intake Form
Please complete the following form as completely and accurately as possible. Based on your answers regarding your education, experience, skills, and interests, you will be considered for employment opportunities with companies who are interested in supporting a neurodiverse workforce.
Please keep in mind that the timing and location of the programs that we work with are hard to predict, so we are not able to guarantee when an opportunity matching your qualifications will happen. When we are able to match you with a position, we will contact you by email and/or phone.
Feel free to reach out to the Neurodiversity In The Workplace team at
with any questions or updates if your information changes.
Last name, first name
What is your phone number (xxx-xxx-xxxx)?
What is your email address?
What city do you live in?
What state do you live in?
At what college/university did you attain your highest degree?
What is/was your major?
What year did you or will you graduate?
What is the highest degree you have attained or are in the process of attaining?
Select 1-3 relevant fields of interest for you.
Computer Networking/Computer Engineering
Please list some of your professional skills (for example: social media marketing, GIS visualization, Microsoft Excel, Photoshop, etc).
Please check any areas of technical skill that you have studied.
Node.JS, React.JS, Angular.JS
Root cause analysis
Quality testing and assurance
What is your current employment status?
Employed full time
Employed part time
Employed through an internship
Why are you interested in changing your current employment situation?
I am having trouble finding work
I am underemployed or not utilizing my education
I do not enjoy my current job
I am overwhelmed by my current job
I am nearing the end of my work contract, internship, or degree program
If an opportunity was identified for you, would you be open to traveling for an interview and potentially relocating for a job?
If you are open to relocating, please check which regions of the USA you would be open to working in.
Mid-Atlantic (DC, Philadelphia, NY)
Never submit passwords through Google Forms.
This form was created inside of Arcpddc.org.