Welcome and thank you for applying for a place on our autistic adult support programme. Please fill out this survey to register your interest.

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* 1. Your contact info:

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* 2. Your pronouns

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* 3. How would you like us to contact you?

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

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* 5. Do you confirm you are over 18 years and Autistic (self-identified or diagnosed)?

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

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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* 7. I am not currently misusing drugs or alcohol

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* 8. I am not actively suicidal

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

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

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* 12. What are your priority areas for support?

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

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* 14. Which place do you want to apply for?

 
 100% of survey complete.

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