Research Sign Up
Mothers of Children with Autism Spectrum Disorder
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Age
blanks
Ethnicity
blank
Marital Status
blank
Current household members (names/ages)
When was your child diagnosed with ASD?
Please Select
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
By whom were they diagnosed?
What was the formal diagnosis from school or medical provider?
Is spirituality part of your life?
Yes
No
Would you say you are currently burnt out from parenting stress?
Yes
No
Do you consider yourself a religious and/or spiritual person?
Yes
No
Is there a group or community you’ve been a part of in the past or currently that reflects your values?Is there a group or community you’ve been a part of in the past or currently that reflects your values?
Yes
No
Does your amount of stress outweigh the resources you have available?Is spirituality part of your life?Does your amount of stress outweigh the resources you have available?
Yes
No
Are you interested in scheduling a zoom interview or would you like to be sent an electronic copy of the survey to fill out?
Zoom Interview
Electronic Survey
Sign in Agreement to the Research Informed Consent
Submit
Should be Empty: