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Needs Assessment Reporting Survey

Needs Assessment for ASD
Reporting Survey

Share your overall participation in the Needs Assessment for ASD dissemination and recruitment activity by completing the following questions. This survey is only for recording the number of individuals you facilitated completing the Indiana Needs Assessment survey (individuals 18 years of age or older). You will not be asked to identify anyone's name or response(s) to the survey.

If you have questions or concerns, please contact Drs. Naomi Swiezy and/or Tiffany Neal, coordinators of this project, directly at

Thank you for your support of ASD in your community! 
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 was your agency working to earn?
4. Did you run into any difficulties or challenges during this activity that we could work to remove or improve upon? 
7. 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!