Global Autism Project Prospective Partners
This section will give us a better idea of your center/institution and the services you provide.
Person filling out this form:
Include country code
Who is the founder of the center
Number of students/consumers at the Center
How many staff (paid and volunteer) work at the Center
How are people referred to the center?
Does the center accept walk-ins
What type of therapy does the center provide?
Sensory Integration Therapy
Does the center take data on the participants progress?
What is the maximum capacity of your center (is your center at capacity or can more students be served)
How often do staff and volunteers receive training?
Who provides the staff training?
Does the center need more staff to provide services to the students/consumers at the center?
How often do students/consumers attend the center?
Please describe the services the center provides
Example: Home based, center based, workshops, vocational training...etc...
Tell us why the center was created and who is it meant to serve?
Does the center charge a tuition or participation fee?
If Yes, how much?
Are the center's services accessible to middle-low- low income people/families?
If No, please explain why: (ex: transportation, tuition fees, outreach etc...
What age group does the center serve
0-6 years old
6-12 years old
12-18 years old
How do students get to the center?
Private/family owned transportation
School bus or van
How is your center funded?
Fees for service
Personal or family income
Grants or scholarships
What is the annual overhead (cost) to run the center?
and CoFunding Application
How did you hear about the Global Autism Project?
Describe in detail your center or organization including it's background, current services and future goals:
(Mission, Vision, values...etc...)
What are you hoping to get out of a partnership with the Global Autism Project?
Does the center need additional funding? If so, approximately how much more funding do they currently need to maintain operations/ appropriately serve the individuals with autism in their community?
*Note- the Global Autism Project does not directly fund centers or organizations.
Are the funding sources sustainable (ongoing fundraisers, yearly donations, student fees) or is there a need for sustainable funds?
Yes, funding sources are sustainable.
No, there is a need for sustainable funds.
Does the government currently provide any funding or support for the center?
If yes, what percentage of center's work is funded by the government?
Does your center partner or have special relationships with other local organizations? If so, please list:
Does the center raise awareness about Autism within their community?
What is your center’s commitment to research?
Are any staff in your center/organization interested in BCBA certification/supervision?
The cost of partnership with the Global Autism Project is $500,000 USD per year. Through Volunteer fundraising, time, training and support, the Global Autism Project can Cofund this cost up to 96%. If chosen as a partner of the Global Autism Project, how much could you contribute to the total cost of partnership?
Contributions based on country's GDP and Income/wealth status based on World Bank information and Purchasing Power Parity.
Does the center have access to quality support and education on Autism Spectrum Disorder?
Where can one access training and support on Autism Spectrum Disorder?
Media and Television
How does the community/culture view autism?
How does the community/culture treat people with autism?
What are the requirements for general education children to attend Primary School?
Who diagnoses children with autism in your community?
Are there special education school or supports in your city?
Are there any Board Certified Behavior Analysts provide services for people with autism in your city?
More than 25
If any, what are the determining factors for if a child with autism receives access to education?
Verbal, basic math and reading, wealth...etc...
Please attach a PDF or scanned document of 10 letters of support gathered from stakeholders within your community that would support you in your venture to partner with the Global Autism Project:
See example application for direction or guidance
Please upload a current service matrix of all the institutions/organizations that are providing services in your city to people with autism. Matrix to include the following: Institution serving children with autism (Name of institution) Director/ Founder Type of institution (e.g. Center, school, hospital) Inclusion? (Yes/ No) Location (City) Socioeconomic status of Children Served Number of Children Served Brief description of the institution/organization
See example application for direction or guidance
Please upload pictures of your center
Please upload a video of some of your services being implemented
The Global Autism Project requires that our service partners establish meaningful collaboration with members of the community and other institutions/ centers/ school where applicable. Please complete the plan for dissemination below. The goal is to build capacity within your own community to be able to provide quality education and services to individuals with autism.
Please describe in detail what your center's 5 year dissemination plan would be during partnership with the Global Autism Project.
Describe how your center would provide training and outreach to you community and other institutions/organizations.
Should be Empty: