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Global Network Survey

Welcome to the Autism Research Institute's global network survey. Please complete the questions below.

If you have any questions and/or need clarification, please contact Nataliya Vasylevskaya at Nataliya@autism.org

Thank you,
Stephen M. Edelson, Ph.D.
Executive Director, Autism Research Institute
San Diego, California USA

1. Name of organization

2. Name and email address of the person submitting this form

3. What year was the organization established?

4. How many people does the organization serve?

5. Name of country

6. Postal mailing address

7. Telephone number and Country code

8. Website address

9. Facebook ID

10. For Non-Profit Organizations: People who you serve

Individuals with autism
Parents
Other family members (examples: grandparents, aunts, uncles, cousins)
Professionals (examples: doctors, psychologists, behavior and speech therapists)
Other

11. Please explain

11. Is the organization approved by the government?

11. For-Profit Organizations and Businesses: People who you serve

Behavior therapists
Physicians, pediatricians, doctors
Psychologists
Nutritionists
Occupational and sensory therapists
Speech therapists
Other

12. Please explain

12. What are the organization's goals? Please include your mission statement if applicable.

13. Please provide a brief biographical description of the director of the organization.

14. List other comments that you would like to bring to our attention.

15. Contacts: Please list names and email addresses.