Contact Information*FirstLast Phone Email* Address Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongoCongo (Brazzaville)Costa RicaCote d'IvoireCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorth MacedoniaNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth SudanSpainSri LankaSudanSurinameSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWalesYemenZambiaZimbabwe Country How did you hear about us? Which date are you able to start? How far can you commute?5 miles10 miles15 miles20 miles or more Which Position(s) are you applying for?Family ConsultantIntensive Individual Support TechnicianRespite TechnicianTherapeutic Integration TechnicianOther Please select the times that you are available to workMorningAfternoonEveningOtherSundayMondayTuesdayWednesdayThursdayFridaySaturday Education Highest level of education achievedGEDHigh School DiplomaSome CollegeAssociate DegreeBachelors DegreeMaster's DegreePh. D School that issued the degree Field of studyEducationEarly Childhood EducationSpecial EducationPyschologySocial WorkNursingOccupational TherapySpeech Language TherapyOther Actual field of study CertificationsPsychologyBehavioral AnalysisFirst AidCPRSpeech TherapyBehavior ManagementCMT (Certified Medication Technician)Other How would you best describe the amount of time you have spent supporting individiuals with autism?3-6 Months6-12 months1-2 years2-4 yearsMore than 4 years Which best describes the ages of the autistic individuals with which you've worked?Under 6 years oldChildren in Elementary SchoolChildren in Middle SchoolChildren in High SchoolAdults Which of the following experience do you have working with autistic individuals?I have supported a special education classroom at a public or private school as an instructional assistant or paraeducator.I have taught or co-taught in a special education classroom at a public or private school.I provided support in a residential facility for children or adults with autism.I have worked at a camp for children or adults with autism.I have provided job coaching for adults with autism.I have provided babysitting or childcare for a child with autism.I have worked for a different autism waiver service agency providing IISS or Respite Services.I have volunteered for a program to support individuals with autism.I have cared for a family member who has autism. Tell us why your experience and qualifications make you a good fit for Celebrate Ability reCAPTCHASubmitReset
