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Needs Assessment Recruitment Participation Survey

Needs Assessment for ASD
Recruitment Participation Survey

By completing this survey, you are expressing your agency's interest   in
assisting with the recruitment for and completion of surveys and interviews for the Needs Assessment for Autism Spectrum Disorder (ASD), collected ongoing by the HANDS in Autism® Interdisciplinary Training and Resource Center within the Department of Psychiatry, IU School of Medicine on behalf of the Indiana Family and Social Services Administration (FSSA).

Information collected as part of the Needs Assessment is confidential and will only be shared in aggregate form to assist the state in understanding the state of autism spectrum disorder (ASD) from across a range of stakeholders (e.g., medical professionals, educational personnel, community providers, justice personnel, first responders, families, caregivers, and individuals with disabilities).

Given your expressed interest, we recommend printing  or saving the instruction sheet after completing the survey. Don’t worry though! If you lose your copy or have any questions about the Needs Assessment promotion, visit our website at

For additional questions, please contact Drs. Naomi Swiezy and/or Tiffany Neal, coordinators of this project, directly at

Ready . . . Set . . . Go! 
1. Information about your Agency and the Contact Person for this activity/promotion: *This question is required.
2. What is your agency's role in your community?
3. Which reward does your agency wish to work towards earning?
4. Before you go. . .  Are you already signed up to receive one of our e-newsletters that deliver fresh content and updates to your inbox? If not, here's your chance!
5. Would any of your friends or colleagues be interested in participating in this activity? If so, please enter their name and email address below to forward them an automatic invitation. 
Space Cell NameEmail Address