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Siblings Together Application Form
The next Siblings Together group will begin in the
Spring of 2024
. This group will fill quickly.
If you have any questions please free contact Bari Turkheimer at
bariturk1227@gmail.com
or Caron Starobin at
caron@starobincounseling.com
.
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* Indicates required question
Email
*
Your email
Participant's Name (Non-Autistic Child)
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Your answer
Participant's Preferred Pronouns
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Your answer
Participant's Age/Grade
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Your answer
Participant's School
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Your answer
Please name and describe mental health and/or medical diagnoses of the Participant. If not applicable, please type, "N/A"
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Your answer
Please identify current mental health providers providing care to the Participant. Identify the type of care (therapist, school counselor, psychiatrist). If not applicable, please type, "N/A"
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Your answer
Sibling's Name (Autistic Child)
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Your answer
Sibling's Preferred Pronouns
Your answer
Sibling's Age/Grade
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Your answer
Sibling's School
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Your answer
Sibling's Diagnoses and age of diagnoses (please include all mental health and medical diagnoses).
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Your answer
Parent/Guardian Name
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Your answer
Parent/Guardian Email
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Your answer
Parent/Guardian Phone Number
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Your answer
Where do you live (City, State)?
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Your answer
What format would you prefer?
In-person (Olney)
Virtual
Clear selection
Please briefly identify some of the concerns/challenges your child faces as a sibling of a child with Autism (e.g., explaining autism to friends and family, increased household responsibilities, feeling isolated).
*
Your answer
A copy of your responses will be emailed to the address you provided.
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