Annual Fund 2024: A Tribute to Ilana Hoffer Skoff
Donate

Menu

Donate

Milestones Autism Resources

4853 Galaxy Parkway, Suite A
Warrensville Heights, OH 44128

Phone: (216) 464-7600

Home Submit an Intake Form Intake Form Individual

Intake Form - I am an Autistic Individual

This form is to be completed by autistic individuals or individuals who suspect they are on the spectrum in order to receive assistance for themselves. If you are a parent or other family member of an autistic individual, please use this form.

DISCLAIMER: Please note that by clicking submit you are agreeing to receive occasional correspondence from Milestones Autism Resources. The personal information collected is only used by Milestones Autism Resources staff. We do not share your information with any third parties. We use your personal information to appropriately process your requests and present you with the information you need, and we may use your demographic information from grant applications.

Si el español es su idioma principal, puede traducir este formulario (y este sitio web) al español haciendo clic en la palabra Español en la esquina superior derecha de la ventana de este sitio web.

AVISO DE RESPONSABILIDAD: Tenga en cuenta que al hacer clic en Enviar, acepta recibir correspondencia ocasional de Milestones Autism Resources. La información personal recopilada solo la utiliza el personal de Milestones Autism Resources. No compartimos su información con terceros. Usamos su información personal para procesar adecuadamente sus solicitudes y presentarle la información que necesita, así como también podríamos usar su información demográfica de las solicitudes de subvenciones.

Yes, I consent. / Sí, doy mi consentimiento. No, I don't consent. / No, no doy mi consentimiento.
Straight/Heterosexual Lesbian Gay Bisexual Pansexual Asexual Queer Questioning I prefer not to answer Other

Submit

Photo Gallery

1 of 22

Need assistance? Let Milestones be your local guide.

Unsure of where to start? Contact our free Helpdesk with your questions, and we will do the research for you!

Visit milestones.org/helpdesk and complete an intake form.