Thank you for contacting SEARCH at UC Riverside. Please take a few moments to comment on your experience. This information is confidential and will help SEARCH improve its ability to help families.

Sincerely,

Dr. Jan Blacher
Professor, UC Riverside
SEARCH Director

We need your formal consent to participate in this survey. All responses are confidential and no identifying information is included. You may skip any items you wish and discontinue participation at any time. Your responses or lack of participation will not impact the help you receive from SEARCH. If you have any questions, please do not hesitate to contact Dr. Jan Blacher at UC Riverside (951) 827-3875. If you give consent, please check below.

Yes, I give consent to participate in this survey.

No thank you, I'm not interested.

Thank you for your participation. Please take a few moments to fill out the information below.

If you have any question' sor comments regarding the conduct of this research or your rights as a research subject, please contact the UCR Human Research Review Board at IRB@ucr.edu , or (951) 827-4811.

1. Zip Code:


2. I contacted SEARCH because of:

My child
My extended family member
My friend
Myself as a person with autism spectrum disorder
Other

Please specify


3. Please indicate the age of the person you are trying to get information for:
   0-3 years
   4-7 years
   8-11 years
   12-18 years
   19-22 years
   Greater than 22 years


4. Please indicate your relationship:
   Parent
   Extended family member
   Friend
   Professional
   Other
   Please specify


5. Which ethnic group do you identify with:
   Anglo-American/White
   African-American/Black
   Hispanic/Latino
   Native American
   Asian-American
   Other
   
   Please specify


6. What is your highest level of education?
Grade 1-6
Grade 7-8
Grade 9-11
HS Diploma
Completed 2-year college
Completed 4-year college
Master's Level
Ph.D. or Other

Please specify
Some college or trade school?

Number of years of trade school
Number of years of college


7. I contacted SEARCH to obtain more information with regard to:
Autism
High-functioning autism or Asperger syndrome
PDD-NOS
Other

Please specify


8. Please indicate your primary reason(s) for initially contacting SEARCH, whether by phone or email:(Check all that apply)
To find out more about SEARCH
To gain information about autism or Asperger syndrome
To learn about educational programs for my child
To learn about social skills programs for my child
To learn about the autism diagnostic process
To find out how to ask questions of my child's teacher or school
To find out what to ask my Regional Center coordinator
To learn how to select a valid treatment for autism
Other


9. What services are you using now?
   


10. Were the responses SEARCH staff provided to you on email or phone helpful?
    
    

    5 - Very Helpful

    4

    3 - Somewhat Helpful

    2

    1 - Not Helpful



11. Would you contact SEARCH again if needed?
    Yes
    No


12. Would you recommend SEARCH to others needing assistance?
    Yes
    No
    
13. What resources are most needed in your area?
    (Check all that apply):
    Autism Resources
    Asperger Resources
    Legal Supports
    Parent Groups
    Recreational opportunites
    Educational Resources
    Early Intervention Resources
    Family Resources
    Autism screening
    Transition issues
    Adolescent/Adult issues
    Other
    
    Please specify


14. Please provide additional comments to help SEARCH improve its service:
    

Please be assured that your responses are confidential. When you click "submit" you will be consenting to participate in the study.