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Needs Assessment Request for Assistance

Needs Assessment: Request for Assistance


Thank you for your interest in completing or assisting someone else to complete the HANDS in Autism® Needs Assessment Survey. This information is important to make sure relevant supports, services and resources are available!

Please let us know below how we can help!


 
1. Fill out your contact information:
2. I need: *This question is required.
3. NOTE: It may take up to 20 minutes to complete the survey

Please select: 
 
3. Who will we be assisting? *This question is required.
3. Will you be the contact point or who should we contact directly?
3. Please fill out the contact information for the individual or alternative contact:
3. Indicate below the type(s) of paper copy surveys you need and how many of each you would like.

Note: Only individual with ASD and family versions of the survey are currently available in Spanish.
Space Cell # of copies in English# of copies in Spanish
Individual with Autism Spectrum Disorder (ASD) (18+ yo)
Family members or Caregivers
School Personnel
Medical & Healthcare Professional
Justice System & Public Safety Personnel
Community Providers
Please indicate below where to mail the paper copy survey(s)*.

Note: Please allow us at least 3 weeks for the survey packet delivery. 
*Due to COVID-19 and Indiana University access restrictions, we cannot guarantee the prompt delivery of surveys. If you would like to access other options (e.g., versions in Word or fillable PDF), please let us know below in the comments.
*This question is required.
3. How can we help? *This question is required.
3. Contact information to hear or learn more about ways we can assist.
3. Would you like to stay engaged or participate in other needs assessment activities or related efforts?