Hurricane Resource Page! Helpful links and supports.
Click here to learn more.

About Us
- About Us
  
  The Autism Society of North Carolina improves the lives of individuals with autism, supports their families, and educates communities.
- Who We Are
- Our Team
- Click Here to Join Our Team
Gain Knowledge
- Gain Knowledge
  
  We provide a wide selection of educational material, media and access to events to help you equip yourself with knowledge to tackle autism. You can find resources on this website or by contacting our staff.
- Autism 101
- Learn with Us
- Learn Online
Find Help
- Find Help
  
  We improve lives through skill-building, clinical services, employment supports, and social recreation. Find support from a specialist or your local chapter.
- Support
- Programs & Services
- Click Here to Find Help Near You
Take Action
- Take Action
  
  Join us in improving lives by making your voice heard, donating, volunteering, or joining us at one of our events.
- Get Involved
- Donate
- Events

Donate

Work with Us
About Us
Gain Knowledge
Find Help
Take Action
Donate Now
Contact Us
Recursos en Español

IGNITE Program Interest Form

IGNITE Program Interest Form

Thanks for your interest in the IGNITE program, with locations in Davidson, Greensboro, and Raleigh. Please complete the following form so that we can learn more about you and your interest in our program.

Participant Info
Participant Name*
First Last
Date of Birth*
MM slash DD slash YYYY
Address*
Street Address Address Line 2 City State
Zip Code*
County*
Email*
Phone*
Parent or Guardian
Participant Name
Prefix First Last
Relationship
Address
Street Address Address Line 2 City State
Zip Code
County
Email
Phone
Please share your ethnicity:*
- Asian
- Black/African American
- Caucasian/White
- Hispanic or Latino
- Native American or Other Indigenous
- Native Hawaiian or Pacific Islander
- Two or More Races
- Other/Unknown
- Prefer not to answer
Questions for Participant
Please select the IGNITE location you are interested in.*
- Davidson
- Raleigh
Please select the program you are interested in applying to: IGNITE for young adults or Jumpstart, our summer program for rising high school seniors or SPARK in Greensboro*
- IGNITE
- Jumpstart
- SPARK
Please select the program you are interested in applying to: IGNITE for young adults or Jumpstart, our summer program for rising high school seniors*
- IGNITE
- Jumpstart
Do you have a primary diagnosis of Autism Spectrum Disorder (ASD) or Asperger's Syndrome?*
- Yes
- No
Are you, the participant, your own legal guardian?*
- Yes, I am my own legal guardian
- No, I have a court appointed guardian - Full Guardiaship
- No, I have a court appointed guardian - Partial Guardiaship
- I don't know
Have you graduated from high school with a diploma or GED?*
- Yes
- No
Are you receiving, or have you received services from the Autism Society of North Carolina?*
- Yes
- No
- I'm unsure
Please describe the service(s)
Do you receive Vocational Rehabilitation Services?*
- Yes
- No
Do you have access to transportation?*
- Yes
- No
Can you describe what you do in a typical weekday?*
What are your special interests or hobbies?*
Please share information about any work or volunteer experience(s)
Please share why you are interested in IGNITE*
Please attach your most recent Diagnostic Evaluation and guardianship paperwork, if applicable, and any other documents that you feel might help us support you.
Drop files here or

Max. file size: 300 MB.
Please share how you learned about IGNITE

Don't Miss

Work with Us

Upcoming Events

Toolkits

Publications

Videos

Blog

Get Support

Talk with a Specialist

ABA & Clinical Services

Skill-Building & Support

Social Recreation

Support Groups

Recursos en Español

Connect

800-442-2762
For the Media
Employees

Apple iTunes App Store

Google Play App Store

Sign up for our newsletter:

Email*
Email
This field is for validation purposes and should be left unchanged.

Translate

Notice of Privacy Practices:
Please click here to view how the Autism Society of North Carolina protects health information. Para leer esta información en español por favor haga clic aquí.
Please click here to read how we protect your personal information.

2024 Autism Society of NC. All Rights Reserved.
Web Design & Development by Brasco ///