Profile of Michigan Resident on the Autism Spectrum

Having an accurate picture of the number and profile of persons with autism in the State of Michigan is vital in advocating for increased supports and services.  Often the data that are used to estimate the autism population are based on information from public agencies that exclude or miss information regarding individuals who are in certain institutions, alternative education settings, or have dual diagnoses or other developmental disabilities and are omitted from that data.  We want to make sure that EVERYONE is counted!  Please help by completing this confidential registry form- note names and personal information will not be shared- we are only looking to use and publish numbers of persons in these categories.

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* 1. Name of person with an Autism Spectrum Disorder

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* 2. Date of birth of person with autism

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* 4. Zip Code

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* 7. At what age was the person diagnosed or labelled on the autism spectrum?

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* 13. Please indicate all Clinical or Medically-Based Services that the person has received to support or treat their autism

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* 18. Please rank the challenging or significant obstacles that the person with autism has faced with 1 being the 'most challenging' and 7 being the 'least challenging'

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