Autism Supportive Group - Interest Survey
Communication Cottage Therapy is going to be launching an Autism Supportive Group starting in the fall of 2023 (September) We firmly believe in the importance of community and doing life together. Navigating anything new can be challenging but we learn best from shared experiences and being able to talk through our situations and have a collection of resources, support, and empowerment to help our children reach their full potential and to thrive while we're in the process. Let us know more about what you'd like to see in a community supportive group as we develop our programming to best meet the interest and areas of need.
BACKGROUND INFORMATION
Name Of Person Completing The Form
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First Name
Last Name
Email
*
example@example.com
Parent/Guardian Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Do We Have Permission To Text or Email Regarding Programming? (Yes/No; Preferred Contact)
ADDRESS (we will not share your address but will use this to plan where our programs would meet and to gain more information regarding community need)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Do You Have A Child Who Has Received an Autism Diagnosis?
YES
NO
In process
At What Age Where They Diagnosed
How Long Did you Have To Wait Prior To Receiving the Diagnosis?
Where Were They Evaluated?
Do You Have Additional Children? (we like to support all members of the family siblings included)
YES
NO
Do you have any other members of your family that have received a diagnosis of Autism?
What Resources Were You Provided After Your Child Received an Autism Diagnosis?
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Group Structure
How Would You Prefer to Meet:
In Person
Virtually
Either Method
How Often Would You Prefer To Meet
Weekly
Every Other Week
1x/month
What is your availability to meet? (day of the week/times)
Would You Need Child Care Provided to Be Able To Attend Supportive Groups/Trainings (etc)
YES
NO
Depends
How many children (include ages) would need to be cared for?
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Understanding Of Autism
What understanding did you have about Autism Prior to the Diagnosis?
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Are there any Cultural/Family Specific Beliefs About Autism That You're Working Through?
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Do you know anyone else who has a child that is Autistic?
What resources have been particularly helpful for you and your family so far?
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What would you like to learn more about?
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What topics do you hope are discussed
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What would you be looking for as a part of a supportive group that you believe that you're needing at this time?
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Room for anything else that you think could be helpful for programming purposes or to learn more about you and your family.
*
Please verify that you are human
*
Submit
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