* 1. How old is the individual(s) with an ASD? Check all that apply

* 2. What is the specific diagnosis of the individual(s) with an ASD?

* 3. Is respite care a service that you or your family is interested in receiving? 

* 4. Are you currently receiving respite care services? Or have you received respite care services in the past?

* 5. Do you feel that respite care services are readily available when needed?

* 6. If respite care services were received, was the worker assigned adequately trained?

* 7. If respite care services were received, what did you like about the services? What would you change about the services received?

* 8. What organization provided the respite care services?

* 9. If respite care services were received, were the services provided to all children in the household or just for the child/children on the autism spectrum?

* 10. Is there any additional information that you would like to share with us? If you would like to be contacted to discuss your experience in more detail, please include your contact information in the space below or email acf_outreach@nb.aibn.com.

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