Adult Contact Form

Please note that AANE is not a hotline and does not provide emergency behavioral health services. If you are experiencing an emergency, contact 911 or go to your nearest emergency department.

Crisis Resources:

National Suicide Prevention Lifeline: 800-273-8255
National Domestic Violence Hotline: 1-800-799-7233
The Trevor Project: 1-866-488-7386
National Domestic Violence Support
Crisis Text Line: 741741

By submitting this form, you are opting in to email communication from AANE. You may update your email preferences at any time by clicking the unsubscribe link at the bottom of AANE emails, excluding confirmation and reminder emails.
Contact information:
Your First Name*
Your Last Name*
Email*
Enter Email Confirm Email
Primary phone number*
Type of phone
Location information:
Street Address*
City*
State*
Postal Code*
Country*
Affiliation
I am a/an ... (choose all that apply)*
Please check all boxes that apply to you.
- Adult with an Asperger/autism profile
- Teen with an Asperger/autism profile
- Parent of adult with an Asperger/autism profile
- Parent of teen with an Asperger/autism profile
- Parent of child with an Asperger/autism profile
- Sibling of an individual with an Asperger/autism profile
- Grandparent of an individual with an Asperger/autism profile
- Partner/spouse of an individual with an Asperger/autism profile
- Ex-Partner/spouse of an individual with an Asperger/autism profile
- Individual whose parent has an Asperger/autism profile
- Other family member of an individual with an Asperger/autism profile
- Educator who works with those with Asperger/autism profiles
- Other professional who works with those with Asperger/autism profiles
- Friend of an individual with an Asperger/autism profile
- No relationship, interested in learning more
Is this your first contact with AANE?*
- Yes
- No
How did you hear about us?*
How can we help?*
Demographic information (optional)
By filling out these fields, you help us gain insight into how we can help our entire community. Your personal information is protected by our privacy policy and is not shared with anyone outside of AANE.
Birth Year
For person with an Asperger/autism/neurodiverse profile
Gender
For person with an Asperger/autism/neurodiverse profile
Pronouns
For person with an Asperger/autism/neurodiverse profile
Ethnicity
For person with an Asperger/autism/neurodiverse profile.
Race
For person with an Asperger/autism/neurodiverse profile.
What are your interests?
This helps us plan programming of interest to our community
What is your professional background?
This helps us plan for employment initiatives.
Hidden
Would you like to receive regular email communications from AANE?
If this question is left blank you will receive email from AANE.
- Yes
- No
Would you like to receive periodic postal mail from AANE?
If this question is left blank you will receive postal mail from AANE.
- Yes
- No
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Name
This field is for validation purposes and should be left unchanged.

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Adult Contact Form

Contact information:

Location information:

Affiliation

Demographic information (optional)