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02.09.2012
Family Support Meeting
02.21.2012
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02.23.2012
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02.26.2012
Ice Skating Event
03.24.2012
Resource Fair
03.28.2012
Disability Awareness Fair



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We are expanding Services for Adults with Asperger's
Please share your ideas with us  ~ We want your input

Interest Survey for Adults with Asperger's Syndrome

Individuals age 20 and over with Asperger's Syndrome or HFA are invited to take this online survey of your interests and preferences. The information you provide will not be shared with anyone outside of the Autism Center without your permission. It will be used for planning purposes only. If you prefer, you may complete a pdf version of the survey and mail it in to the Sonya Ansari Center for Autism, 2505 E. Jefferson Boulevard, South Bend, IN 46615. If you have any questions, please email Lynn Sayre.

Please tell us your age, gender and email address

Age   Gender (m/f)  
Email address

Please tell us your name and phone number (optional)
Name
Phone number

Please tell us your preferences by checking (Y)es or (N)o or (U)ncertain
What type of group would you prefer?
I would be interested in getting together regularly with a group of individuals in this age group with Asperger's Yes No

I would like the group to focus on issues that the members bring to the group meetings (support group)

 Yes No Uncertain

I would like to hear educational or informative speakers at the meetings (educational group)

Yes No Uncertain

 

I would like the group to be unstructured and group directed (social group)

 Yes No Uncertain

When would you like to meet?

I would like the group to meet weekly

 Yes No Uncertain

I would like the group to meet monthly

 Yes No Uncertain

The group should meet on a weekday evening

 Yes No Uncertain

The group should meet on a weekday daytime

 Yes No Uncertain

The group should meet on the weekend

 Yes No Uncertain

Additional group options

I would like the group to be part of a hobby or interest group with others with Asperger's

 Yes No Uncertain

My hobby or interest is:

I currently attend group meetings for individuals with Asperger's

 *Yes No

*If Yes, please identify the group you currently attend:

Where would you like to meet?

The best location for a meeting for me would be:

I would be interested in individual counseling or coaching

 Yes No Uncertain
Other Comments

Ansari Center for Autism
2505 E. Jefferson Blvd. • South Bend, IN 46615
(574) 289-4831
autismcenter@logancenter.org