Interested in working with us? 
Neurodivergent therapists providing equitable access to neurodiversity-affirming, child- and family-centered services in LA. 
Sign in to Google to save your progress. Learn more
How did you hear about us?
Hi! Nice to meet you. What is your full name? 
What do you prefer to be called?
Pronouns? 
Phone number?
Do you speak any languages other than English? Do you have any knowledge/training in American Sign Language?
Email?
When are you hoping to start?
MM
/
DD
/
YYYY
When are you available to see clients?
We currently provide services for children and families in these areas (this will expand with time)! Please select any locations that work best for you:
Are you comfortable working in the following settings? 
Are you comfortable working closely with teachers and parents and providing guidance?
We value a neurodiversity affirming lens and the therapeutic power of lived experience. We'd like to share that everyone on our team identifies as neurodivergent and we would love to welcome more neurodivergent team members. Keep in mind that this requires consistent unlearning/learning about collaborating with people with different neurotypes! We aim to create a universally accommodating and accessible workplace. Do you have personal or professional experience with neurodiversity? 
What does accommodating your colleagues mean to you? How would you do things differently to accommodate your Autistic/ADHD/OCD/Dyslexic colleagues?
What are you passionate about? Maybe it's stamp collecting, maybe it's opera singing! We want to know what makes you happy. 
Affirming support collaborative operates on a non-hierarchical structure. We value the contributions of all team members and aim to provide equitable wages within our means and share our resources within the team. Pay is not only based on our education level or previous experience, but that we all bring our own value and knowledge to add to the lives of neurodivergent children. It is highly valuable if you have previous experience with working together in a collective/non-hierarchical capacity since this organization was started by a group and we are committed to maintaining this community. What feelings does this structure/ideology bring up for you? 
Are you open to learning a radically new approach and perhaps a job that requires a little more collaboration and dedication to showing up for your peers than previous roles?
How do you show up consistently to support your clients and their families?  *
What does equity mean to you?
To ensure the highest quality of care, ASC is looking for a one year commitment for this position. Does that time line work for you? *
This is a "start up", we are in our second year, and we are still very grassroots. Are you ready for the challenges that that can bring? (e.g. insurance late to reimburse leading to payroll delays, technological glitches, helping reach customer service, communicating directly with families, etc.)
What kind of role are you looking for? 
Clear selection
Do you want to share a work experience or history that has been impactful on you?  *
Do you have experience with or interest in any of the following? 
Any questions or comments? Leave them here thank you! 
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report