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Your First Name * Your Last Name * Your Email * Confirm Your Email * Enter Password * Confirm Password *
Demographics Your Position * Select one Administrative - CEO / Executive Director / Director Administrative - Curriculum Director Administrative - Early Childhood Administrative - Early Intervention Administrative - Higher Education Administrative - Principal Administrative - Special Education Director / Coordinator Administrative - Pupil Personnel Director / Coordinator Administrative - Superintendent Administrative - Other Adult Services - Adult Day Program Provider Adult Services - Adult Residential Provider Adult Services - DODD Service and Support Administrator Adult Services - Job Coach Adult Services - Vocational Rehabilitation Counselor Adult Services - Vocational Services Provider Adult Services - Other Business - Sales Business - Public Relations / Marketing Business - Other Early Childhood - Head Start Early Childhood - Preschool Early Childhood - Other Early Intervention - Early Intervention Specialist Early Intervention - Service Coordinator Early Intervention - Other K-12 Education - General Education K-12 Education - Paraprofessional / Instructional Assistant K-12 Education - Special Education / Intervention Specialist K-12 Education - Student K-12 Education - TOD - Teacher of the Deaf K-12 Education - Transition Specialist / Coordinator K-12 Education - TVI - Teacher of Students with Visual Impairments K-12 Education - Other Families - Family Member Families - Parent Families - Other Health Care - Nurse Health Care - Pediatrician Health Care - Physician Health Care - Other Higher Education - Instructor Higher Education - Professor Higher Education - Researcher Higher Education - Undergraduate / Graduate Student Higher Education - Other Individual with Disability Related Services - Assistive Technology Specialist Related Services - Audiologist Related Services - Behavior Specialist / Therapist Related Services - COMS - Certified Orientation and Mobility Specialist Related Services - Interpreter Related Services - Mental Health Provider Related Services - Occupational Therapist Related Services - Parent Advocate Related Services - Parent Mentor Related Services - Physical Therapist Related Services - Psychologist Related Services - Speech-Language Pathologist Related Services - Social Worker Related Services - Support Staff Related Services - Technology Specialist Related Services - Transcriber Related Services - Other
Years of experience working or living with individuals with an autism spectrum disorder * Select one 0-5 5-10 10-15 Over 15 No experience
Age range of the individual or students with ASD with which you currently live or work * Select one 0-5 6-12 13-21 Over 21 All Ages Multiple Ages
Prior coursework, staff development, or trainings on ASD topics * Select one Life Experiences As A Parent Or Guardian Having A Child With ASD Life Experiences As An Individual With ASD 1-2 Hours Half Day Full Day More Than A Day, But Less Than A Week One Course A Few Courses A Certificate Program In ASD A Degree Program In ASD Instructs Others on ASD
Your Gender (Optional) Select one Male Female
Your Race (Optional) Select one American Indian or Alaska Native Asian Black or African American Hispanic / Latino Multi-Racial Native Hawaiian or Other Pacific Islander White
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The Ohio Center for Autism and Low Incidence (OCALI), together with it's collaborative partners in the Autism Internet Modules (AIM) project, are interested in gathering data and information regarding the use and effectiveness of the AIM content and platform. Do you give permission for the AIM staff to contact you in the future via email for participation in this research? * No Yes
Send me e-mail updates when new AIM modules and features are available: No Yes