We appreciate your interest in becoming a member of the Global Autism Collaboration.

Our mission is to network with organizations worldwide to collaborate on a standard of care for children and adults on the autism spectrum, and to establish long term financial viability. Please find the application below. Feel free to use as much space as you feel necessary to answer the questions.

Organization name:

First Name

Last Name

Title

Address

City

State

Zip

Telephone

Email (required)

Website

Your organization is domiciled in which country?

The people whom you serve are:

 regional national international

Your organization is: (check all that apply)

 non-profit non-profit, charity for-profit, govt. primarily lobbying for-profit other

If other:

If your organization is a govt. approved non-profit,
please provide your federal id number:


or

 No Federal ID

4. Your organization has been in existence since:

5. Your organization serves the autism community by:

6. Your organization serves approximately how many people?

Please clarify in what way (for example, membership, newsletter subscribers,
daily website hits, grants, etc.).

7. Your organization's mission statement and goals are:

8. Please provide a brief 3- to 5-sentence biographical description of the director of the organization:

9. Please describe how your organization will further or has already furthered the mission of the Global Autism Collaboration, either directly by working with member organizations or indirectly.

10. Is your organization opposed to any main area of intervention, such as behavioral, biomedical, medical, and/or sensory? If so, please explain.

11. List all board members and/or key personnel in your organization, and note those directly affected by autism and their relationship to the affected individual (e.g., Bill Smith, secretary, father of two boys with autism).

12. List other considerations you would like to bring to the attention of the membership committee.

13. Best contact information for you:

By submitting this form, you agree to GAC's Structure and Policy