Register

Register for Intake Appointment

We are excited to meet you! Please fill out the form below and let us know which program you might be interested in joining. If you’re not sure of the program you’d like to register for, simply contact us for an intake interview and we will determine the best program for your needs at the time of the intake appointment. See our Programs page for more information on programs available.

Criteria for participant interested in attending our programs

At least 18 years of age and have completed high school
Has Autism Spectrum Disorder – ASD (includes Asperger’s Syndrome, PDD-NOS)
Fundamental communication skills – ability to communicate verbally
Does not require one-on-one intervention and/or prompting for safety, behavioral support or comprehension

If the individual applying meets this criteria, please fill out and submit this form. We will contact you about your interest in attending our program(s).

Program Registration

"(Required)" indicates required fields

Applicant First and Last Name(Required)

First Last

Applicant Email(Required)

Applicant Phone(Required)

Applicant Birthday(Required)

Applicant Address(Required)

Street Address City State ZIP Code

Has the applicant graduated high school?(Required)

Yes

Are you the parent/guardian of the applicant applying for our program(s)?(Required)

Yes

Parent/Guardian Information

Parent/Guardian First and Last Name

First Last

Relationship to applicant

Phone

Address

Street Address City State / Province / Region ZIP / Postal Code Country

In order to complete the registration you must select one program of interest.

Please select your primary program of interest:(Required)

What are you hoping to gain from this program?

Please check the box below:

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Register for Intake Appointment

Criteria for participant interested in attending our programs

Program Registration

Parent/Guardian Information

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