Autism Friendly intake form

Thank you for your interest in an Aspect Autism Friendly Consultation/Training.

Once we have received this completed form, our team will follow-up within 7 business days.

If you have any questions regarding this form, please call us on: 1800 277 328 or email: customerservice@aspect.or.au

Organisation Details & Contact Person

Organisation Name *

Size of Organization – number of employees *

0 – 1010 – 100100 – 10001000 – 10,000More than 10,000

Average Number of Customers per week who come in contact with your service *

0 – 100100 – 10001000 – 10,00010,000 – 20,00020,000 – 50,00050,000 – 100,000100,000 +

Contact's first name *

Contact's last name *

Title/Position

Email *

Mobile *

Contact's Address *

Street address *Street address line 2

City *

State *

Postcode *

Country

How did you hear about Aspect? *

Internet SearchWord of MouthSocial MediaOnline AdvertisingExpo or eventAspect employeeOther

Please provide *

Consultation / Training

Autism Friendly partners with organisations to create environments which support and include Autistic people.

Please indicate the services your organisation would like to receive : (tick any that apply) *

Development of an Autism friendly environment Development of Autism Friendly resources such as sensory map, visual story or quiet room Staff training Support for an Autism Friendly event such as Quiet Hour or Early BirdsAutism Friendly accreditationAutism Friendly employment Other

Choose as many options that apply

If other, please specify *

When would you like the service to take place ? *

Approximate # of attendees? *

How would you like the training delivered? *

Face-to-faceWebinarBoth

*Please note travel and accommodation costs are extra (if applicable).

Estimated duration of training *

Half dayFull day2 hours Other

Please specify desired timing *

Any other information you would like to share regarding the outcomes or other requirements

By ticking this, I confirm that all information supplied at the time of completion is accurate *

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