CARD - USF Registration Form

Para acceder el formulario en español, haga clic aquí

Attention case managers: CARD operates under a self-initiated service model, which means we follow a self-referral policy. While you are welcome to assist clients with the registration process, please do not register clients on their behalf without their full knowledge and understanding of the services provided by CARD-USF.

CARD is a state-funded organization that provides free coaching, training, guidance, and assistance to increase knowledge and make life better for individuals diagnosed on the autism spectrum across their lifespan. To register for services, please complete the form below.

For more information about the services we offer and the registration process, please visit our FAQ page . You may also contact our Resource Office by phone at 813-974-2532 or email at card-usf@usf.edu.


Constituent (Person with Autism) Information

A constituent is the person needing services. Please complete the following information about the individual on the autism spectrum.

Name of person with Autism/Related Disability
Demographics
(This information is NOT reported. We only ask so we can address the constituent according to their preference.)

(Hispanic is an ethnic category for people whose origins are in the Spanish-speaking countries of Latin America or who identify with a Spanish-speaking culture. Individuals who are Hispanic may be of any race.)
Mailing Address (If your county of residence is not listed you are NOT in our eligible catchment area. Please visit the Statewide CARD websiteto find the Center that serves your area.)
Medical
(CARD services are free. We do not bill your insurance. We use this information to help find resources that accept your insurance.)
Receiving services from another agency?

Parent/Guardian Information (if applicable)

If registration is being completed for a minor or an adult with a legal guardian/Power of Attorney, please complete the following information. A legal guardian has a court order that grants guardianship responsibilities. Power of Attorney is a legal document that provides authority to act on another person's behalf in specified legal and financial matters. In both cases, CARD-USF will request a copy of these documents before assigning a consultant.

Parent/Guardian/POA
Mailing Address

Contact Information

Please provide the best contact person for us to follow up with.

Who should we contact?

(CARD-USF currently has consultants who speak English and Spanish. For other languages, we can work with a friend or family member who can translate for you.)
Contact Methods

Main Concerns