Welcome and thank you for your interest in applying for a place on the Music for Wellbeing programme. Please fill out this survey to finish your application with Thriving Autistic. We will be in touch as soon as possible to let you know if your application has been successful.

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* 1. Your contact info:

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* 2. Your pronouns

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* 3. Would you like us to store your information for entry onto a subsequent iteration of this programme if this programme application is unsuccessful?

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* 4. Would you like to register for group 1, group 2 or both?

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* 5. In what year were you born? (enter 4-digit birth year; for example, 1986)

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* 6. Do you confirm you are aged between 18 - 24 years and Autistic (self-identified or diagnosed)?

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* 7. Do you have any access needs? (Select all that apply)

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* 8. Why are you interested in this programme? 

The following series of questions are a safety check on your wellbeing. This group programme is not suitable for those at risk. If you are in danger of harm please tell someone and see your GP.

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* 9. I am not currently misusing drugs or alcohol

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* 10. I am not actively suicidal

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* 11. I am not at risk of harm to myself or others

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* 12. I understand that if a risk is disclosed during any of the workshops, then the facilitator is obliged to break confidentiality and seek support for me.

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* 13. Who should we contact in case of concern for your safety?

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* 14. Do you have any other comments, questions, or concerns?

 
 100% of survey complete.

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