Virtual Program Interest Form

Thank you for your interest in our Virtual Program for Level 1 Autistic Adults! 

My Autism Connection (MAC) offers a unique virtual program designed to support autistic adults through engaging activities, skill-building workshops, and social connections — all from the comfort of home.

Please complete the form below so we can learn more about you and how we can best support your goals. Once submitted, a member of our team will reach out to you with more information about the next steps.

We look forward to connecting with you!

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CONTACT INFORMATION

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LOCATION

PROGRAM INTEREST

Are you currently on the Tampa waitlist?
Did you receive an official diagnosis from a medical practitioner?
If No, do you believe you meet all the criteria and would benefit from a program designed for ASD individuals?
What aspects of the program are you most interested in? (Check all that apply)

ADDITIONAL QUESTIONS OR NEEDS

NEWSLETTER SIGNUP

Would you like to join our mailing list for updates and announcements?

CONSENT

I consent to be contacted with more information about the Virtual Program.
Consent is required to submit this form.