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Surveys
2014
October
A
Autism Gradschool Survey
Autism Gradschool Survey
CONSENT FORM
0%
Exit Survey
You are requested to take part in research about the ASD patients and what makes them happy. The research is being conducted for a classroom project by four students. We ask that you read this form before agreeing to be in the research.This survey should take about 3 to 5 minutes to complete. Participation is voluntary and responses will be kept anonymous. If you choose not to be in the study you can withdraw at any time. The report of this research will not be made available to the public and will not include your name or any other individual information by which you could be identified. The records of this study will be kept private. Anything you tell us will remain confidential. In any sort of report of the study, we will not include any information that will make it possible to identify you.
I Agree
What is the age group of the person having autism ?
1 – 17
18 – 25
26 – 40
40 and more
At what age was person diagnosed with autism?
What are the activities that person with autism enjoys doing?
Before being diagnosed were you familiar with autism?
Are there any diet restrictions for the person with autism ?
Yes
No
Others
Does the person with autism has any difficulty in expressing his needs?
Yes
No
How does the person with autism feels when he is in public or some crowded place?
Uneasy and Uncomfortable
Calm and Quiet
Cannot say
When in crowd or party can the person with autism bear the noise ?
Yes
No
Other expressions
Does the person with autism relate to anyone speaking with him/her?
Yes
No
Not necessary
What care should be taken when interacting with the person with autism ?
Thank you
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