RegistrationWe're so glad you found us! In order for us to best help you, please be sure to fill out everything accurately and completely. User InformationUser Name * First Name * Last Name * Contact InformationEmail * Phone * How do you prefer to be contacted? * Phone EmailAddressStreet Address * City * State * Select option--Please Select--AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUnited States Virgin IslandsUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingCounty * Legislative District: * Please look up your legislative District: href=http://app.leg.wa.gov/DistrictFinder. Your registration can not be approved with out a correct district. Select option012345678910111213141516171819202122232425262728293031323334353637383940414243444546474849Zip * Who Am I?I am * Please select only one option Select option- Please select -A family member of a person with ASD or another DDA person with ASD or another DDA professional in this fieldA volunteer or I wish to become a volunteerI am contacting WAAA because * Please chose an option Select option- Please select -I need assistance with insuranceI need assistance with special educationI need family support and resourcesI am interested in volunteeringI am a professional in the field and wish to receive periodic updates (newsletter/events)Other help (if any) * If you are interested in volunteering, please tell us how you can help: * Select optionFundraisingGift of TimeEventsAdministrative SupportFamily SupportNone of the AboveOther, please specifyWould you like to receive our monthly newsletter? * Yes NoHow did you hear about WAAA? * Please provide any additional information for us to best help you. * Demographic InformationWe are asking the following questions to gain a better understanding of the different types of families that WAAA is serving and how we can better serve the whole community. Providing this information is optional and will be kept strictly confidential if provided.What is the primary language spoken in your home? * Select option--Please Select--EnglishAmharicArabicCambodianChinese-CantoneseChinese-MandarinChinese-UnspecifiedHindiJapaneseKoreanLaoMarshallesePunjabiRussianSamoanSomaliSpanishTagalogUkrainianVietnameseWhat is your household size? * Select option--Please Select--12345678910+Prefer not to SpecifyWhat is your annual household income? * Annual Household Income is used for internal purposes and will not be shared outside of WAAA. Approximations accepted. Which of the following best describes your racial or ethnic heritage? * Please select an option Select option- Please select -White/CaucasianBlack/African AmericanHispanic/LatinoAsianNative American/AlaskanNative Pacific Islander/Native HawaiianMulti-racialPrefer not to answerOtherFamily Empowerment Survey Questions (for parents only)This survey collects information about families with children. It asks if parents feel empowered to take part in their child's health care. We will use the information to improve services for families and children with autism spectrum disorders and other developmental disabilities. Choose the answer that best applies to you as a parent right now. There are no right or wrong answers. Answer based on your experience with your child's services. Examples of services are listed at the bottom of the page. For sentences that do not relate to you, choose “Not Applicable”.I am able to make good decisions about what services my child needs. Select option0=not applicable1=never2=seldom3=sometimes4=often5=very oftenI am able to work with agencies and professionals to decide what services my child needs. Select option0=not applicable1=never2=seldom3=sometimes4=often5=very oftenI know what services my child needs. Select option0=not applicable1=never2=seldom3=sometimes4=often5=very oftenWhen necessary, I take the initiative in looking for services for my child and family. Select option0=not applicable1=never2=seldom3=sometimes4=often5=very oftenI have a good understanding of the service system that my child is involved in. Select option0=not applicable1=never2=seldom3=sometimes4=often5=very oftenThank You!Thank you! Our Membership Services Coordinator will review your information and connect you with the best person at WAAA to assist you, as well as provide you with other great membership resources. Please note, the information you provided is reviewed weekly, on Fridays. If you need urgent assistance please call WAAA to speak to an advocate 425-836-6513.