Individual Sign-Up – Neurodiversity Employment Network

Basic Information

Name (First & Last): *

Email *

State of Residence *

About Yourself

Information entered in these fields will help us provide you with the appropriate resources.

I am a(n)… *

Job Seeker

Job Seekers are neurodiverse individuals actively seeking meaningful employment.

Current Education *

Select the level of education you are currently receiving. If you are not currently receiving an education, select the highest level of education you have completed.

Diploma

School Name *

Graduation Date *

Academic/Vocational Interests

By providing us with a list of your interests, we can assist in providing resources related to them.

Degree

University *

Major *

Date of Degree Completion *

If you have not yet completed your degree, select the date on which you will complete your degree.

Degree Earned *

If you have earned more than one degree, select the highest level degree you have earned.

Employer

Employers are individuals who work for an organization that hires neurodiverse candidates, or will hire neurodiverse candidates within the next six months.

Name of Organization *

Role at Organization *

Status of Neurodiversity Program *

Provider

Providers are individuals who work for an organization that offers neurodiverse hiring services for Job Seekers, Educators, and Employers.

Name of Organization *

Role at Organization *

Your Support for Neurodiverse Hiring *

I can help start a neurodiverse support program
I can match job seekers with employers
I can provide training for future employees
I can provide training for employers’ supervisory staff
I can provide job coaching for employees

As a Provider, tell us about what kinds of supports you offer now. Check all that apply.

Educator

Educators are individual instructors, school administrators, and support staff who educate neurodiverse students in both K-12 settings and post-secondary education.

Name of School *

Role *

School Type *

Status of Neurodiverse Support Program *

Your Connection to Us

What do you hope to gain by connecting to the Neurodiversity Employment Network? *

How will you contribute to the Neurodiversity Employment Network?