Guest Intake Form
Interested in being a guest on Today's Autistic Moment?  Answer the questions in this form and submit it to me for review. Please read carefully the Do's and Don't's page on the website first.  You will be asked to agree to them in the intake form.  If you disagree, you will not be asked to be a guest. The form will be reviewed.  If the information you provide indicates that you would be a great guest, you will be contacted.  Guest intake forms are accepted from everyone regardless of race, sexual orientation, gender identity (cis-gender and nonbinary), disability, religion (or no religion at all), immigration status, marital status.  I only know the English language and therefore I am not able to interview guests who speak other languages. I am terribly sorry about that.
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Name and Gender Pronouns *
State, Country and Time Zone *
Email Address *
Are you Autistic? *
During 2023 the focus will be on the strengths and achievements of Autistic Adults. What topics would you like to talk about? *
What experience or training do you have about the topics you chose in the last question? *
Why do you want to be a guest and talk about the topics you mentioned? *
Do you have resources to mention during the interview?
The interview will be recorded on Zoom.  Can you do a virtual interview? *
What supports might you need during the interview? Whether you are verbal or nonverbal, you are welcome to fill out this form.  If you will be using a device to communicate or have a translator with you, please let me know.  
Are there any subjects, words or phrases you are sensitive to that might make you uncomfortable during the interview?
Have you read the Do's and Don't's page? *
Do you agree to do the interview and observe the rules in the Do's and Don't's page? *
Is there anything else that you would want me to know about you regarding being a guest? *
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