Application for Autism Study

Name

Email Address

Child's First Name

Child's Birth Year (1985 or Later Only)

How Many Parents Will Participate? How Many Parents Will Participate? 1 Parent Will Participate 2 Parents Will Participate

Has your child been officially diagnosed with autism or on the autism spectrum? Has your child been officially diagnosed with autism or on the autism spectrum? Yes No

Do you have the exact birth time, birth date, and birth city from an official birth certificate for all of the participants of this study? Do you have the exact birth time, birth date, and birth city from an official birth certificate for all of the participants of this study? Yes No

Do you agree to complete a detailed questionairre about your life and attend a 1 1/2 hour long session via phone or online free of charge? Do you agree to complete a detailed questionairre about your life and attend a 1 1/2 hour long session via phone or online free of charge? I Agree

Questions or Comments