Center for Autism & Related Disabilities

Para acceder el formulario en español, haga clic aquí

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 First Middle Last

Demographics Date of Birth Sex
Gender, if different (This information is NOT reported. We only ask so we can address the constituent according to their preference.)
Race
Are you of Hispanic descent? (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 Street City State Zip Code County

Medical Diagnosis Doctor or facility who gave the ASD diagnosis
Health Insurance (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?

Agency for Persons with Disabilities (APD)

Child Care Assistance

Disability Benefits like SSI (Supplementary Security Income)

Early Intervention for your Infant or Toddler

Food stamps (SNAP)

Group Home/Intermediate Care Facility (ICF)/Institutional Care

Head Start or Early Head Start

Housing Assistance

Medicaid

Phone or Fuel Assistance

TANF (Temporary Assistance for Needy Families)

Unemployment

Visiting Nurse or other Home Visiting like Healthy Families

Vocational Rehabilitation (VR)

WIC (Women, Infants, [&] Children Nutrition Program)

Other

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 Registrant is an adult without a legal guardian. First Name Last Name Relationship

Mailing Address Street City State Zip Code

Contact Information

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

Who should we contact? Registrant Parent/Guardian Other

First Name Last Name Relationship

This person will be acting as a translator (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 Phone Number Type

Best Time to Call Morning Afternoon Evening

Email Address

Main Concerns

Please describe your main concerns and what types of assistance you are seeking.