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

Name *

First

Last

Email *

Phone

LOCATION

City

StateALAKAZARCACOCTDEDCFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWYChoice 55

PROGRAM INTEREST

Are you currently on the Tampa waitlist?

• Yes
• No

How do you identify? *

• Level 1 Autism Spectrum Disorder (ASD)
• Neuro-diverse (ND)
• Other

If you answered Yes to above, are you self-diagnosed?

• Yes
• No

What aspects of the program are you most interested in?

• Twice-monthly virtual sessions
• Monthly social outings
• Specific topics (e.g., life skills, emotional well-being, workplace readiness, etc.)
• Connecting with others in a safe space
• Other (use field below)

ADDITIONAL QUESTIONS OR NEEDS

What would you like to know about the program?

Do you have any accessibility needs or accommodations?

NEWSLETTER SIGNUP

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

• Yes
• No

CONSENT

How did you hear about this program?MAC WebsiteSocial MediaFriend/FamilyNewsletterOther (use space below)

Other

with like Other

I consent to be contacted with more information about the Virtual Program. *

• Yes

Consent is required to submit this form.

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