Hussman Center for Adults with Autism Program Interest Indication Form

First Name:

Last Name:

Email:

Programs run for four weeks starting the week of July 8th, 2024. Recreational Activities group will begin the week of June 17th and run for 4 weeks.

How many programs would you like to participate in this summer?

12

Top Program Choice:

ArtFitnessHealthy RelationshipsRecreational ActivitiesSelf ManagementTrivia

Second Program Choice:

ArtFitnessHealthy RelationshipsRecreational ActivitiesSelf ManagementTriviaI do not have a second choice

Third Program Choice:

ArtFitnessHealthy RelationshipsRecreational ActivitiesSelf ManagementTriviaI do not have a third choice

Selecting a program indicates that you are interested in attending that program.

Selecting a program does not guarantee program acceptance. You will be notified if there is space in the programs for you to attend.

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