Autistic Career Collective of Colorado Membership Form

*1.Name: What is your First Name?(Required.)

*2.Name: What is your Last Name?(Required.)

*3.Birthdate: Please enter your Birthdate (MM/DD/YYYY)(Required.)

*4.Contact Email: Please enter your Email(Required.)

*5.Gender: How do you identify?(Required.)

Nonbinary

Man

Woman

Prefer to self-describe:

*6.Race/Ethnicity: Which race or ethnicity best describes you? (Please choose only one)(Required.)

American Indian or Alaska Native

Asian or Asian American

Black or African American

Hispanic or Latino

White/ Caucasian

Multiple Ethnicity/ Other (please specify):

*7.Education: What is the highest level of school you have completed or the highest degree you have received?(Required.)

Less than high school degree

High school degree or equivalent (e.g., GED)

Some college but no degree

Associate degree

Bachelor degree

Graduate degree (e.g., Masters, PhD, M.D)

*8.Location: What is your current city?(Required.)

*9.Location: Please provide the zip code you live in? (5 digit zip code)(Required.)

*10.I am or think I may be:(Required.)

I am a self-diagnosed adult with autism

I am a medically diagnosed adult with autism

I am a neurodivergent adult

11.Career: Are you currently employed?

Yes

*12.Career: Please select what best describes what career you are in:(Required.)

13.OPTIONAL: Name of Employer

*14.By registering or attending the meetings/events hosted by Autistic Career Collective of Colorado, you agree that you have read and acknowledged our ACCC Guidelines.(Required.)

I agree I have read and acknowledged the ACCC Guidelines

15.OPTIONAL: What is your interest or reasoning behind in joining the Autistic Career Collective of Colorado?

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