Submit a Resource

First, we’ll need some information about you:

1. What is your name?
2. Email Address:
3. Phone Number:
4. What is your connection to Asperger’s?
   • I have Asperger’s
   • My friend or loved one has Asperger’s
   • Professional interest
   • Just curious
   • Other Please elaborate:

Now we’ll need some information about your resource:

5. Resource Name:
6. Mailing Address
   • Street:
   • City:
   • State:    Zip:
7. Website:
8. Phone:
9. Fax:
10. Email:
11. What type of resource is this? (Check all that apply)
    • Acute Short-Term Care
    • Advocacy for Adults
    • Alternative Treatment
    • Asperger Education
    • Assistance with Daily Living
    • Assistive Technology Resource
    • Autism / Asperger Organization
    • Behaviorist
    • College
    • Dentist
    • Diagnosis and Evaluation
    • Driver's Education
    • Ed Assessment / Intervention
    • Educational Consultant
    • Employment Services
    • Financial planning
    • Homeschooling
    • Housing
    • Legal
    • Life Coaches for Adults
    • Teen Medical
    • Multi-Service Agency
    • Neurologist
    • Neuropsychologist
    • Occupational Therapy
    • Ophthalmologist
    • Parent Support Group
    • Pediatrician
    • Pharmacist
    • Pysical Therapy
    • Post-High School
    • Psychiatrist
    • Psychologist
    • Psychopharmocologist
    • Publication
    • Recreation
    • Residential Treatment / Hospital
    • Respite Care
    • Resource Organization
    • School (Elementary)
    • School (Middle)
    • School (High School)
    • School Vacation Mini-Camp
    • 766 Advocate
    • Sexuality / Gender
    • Social Skills Groups
    • Social Worker
    • Spanish-Speaking
    • Speech and Language
    • State Agency
    • Substance Recovery
    • Summer Program
    • Theatre / Social Skills
    • Therapist / Counselor
    • Tutoring Services
    • Videos
12. What age group does this resource serve?
    • Child
    • Teen
    • Adult
    • Family
13. Please provide some basic information about this resource:
14. Is this a self-referral?
    • Yes
    • No
15. Why are you recommending this resource?
16. Age of Students:
17. 766 Approved:
    • Yes
    • No
18. Cognitive Ability:
19. Program Type:
    • Day
    • Boarding
    • Both
20. Season:
    • Summer
    • School Year
    • Both
21. Finally, please let us know if we can share your contact information with others who are interested in learning more about the resource you’ve recommended:
    • Yes, others may contact me about this resource
    • No, do not share my information with anyone