Express (Surbiton) Community Interest Company Question Title * 1. How often would you use Express? more than once a week at least once a week at least once a fortnight at least once a month never Question Title * 2. Do you feel there is a need for more support in the community for children and young people with ASD and their carers? Yes No Question Title * 3. What is your child's diagnosis? (please tick all that apply) Autism Spectrum Disorder Childhood Autism High Functioning Autism SLD Aspergers ADHD ADD Other (please specify) Question Title * 4. What age is your child with ASD? 0-4 5-11 12-17 18-24 25+ Question Title * 5. What gender is your child with ASD? Female Male Question Title * 6. What education provider does your ASD child attend? Mainstream Unit within a Mainstream Special school Further Education Other (please specify) Question Title * 7. What would you and your family use Express for? (please tick all that apply) Social opportunity for young person with ASD Social opportunity for carer Social opportunity for the family Advice Work experience for young person with ASD Work opportunity for carer Volunteer opportunities Training Meetings Sensory room Information Other (please specify) Question Title * 8. What is your postcode? Question Title * 9. If you would you like to receive further information about Express, please provide your email address. Question Title * 10. Please let us know if there is any way you can help with fundraising. Do you have fantastic employers or know local businesses who would like to offer time, services, money, materials or advice to help get Express started and be involved at the start of this exciting new project! Email us at ask.express@yahoo.com. Thank you. Done