Submit a Resource

About You

1. First, we’ll need some information about you:
2. * What is your name?
3. * Email Address:
4. Phone Number:
5. * 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:
6. * Is this a self-referral?
   • Yes
   • No
7. Why are you recommending this resource?

About Resource

1. Now we’ll need some information about your resource:
2. * Resource Name:
3. Mailing Address
   • Street:
   • City:
   • State:    Zip:
4. Website:
5. * Phone:
6. Fax:
7. * Email:

Resource Details

1. 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
   • Other Please specify:
2. What age group does this resource serve?
   • Child
   • Teen
   • Adult
   • Family
3. * Please provide some basic information about this resource:

School Info

1. Age of Students:
2. 766 Approved:
   • Yes
   • No
3. Cognitive Ability:
4. Program Type:
   • Day
   • Boarding
   • Both
5. Season:
   • Summer
   • School Year
   • Both

Privacy

1. * May we 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

Submit