Full Name *

Email *

Country *

Country

• Afghanistan
• Albania
• Algeria
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• Andorra
• Angola
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• Antarctica
• Antigua and Barbuda
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• Armenia
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• Australia
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• Bahrain
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• Barbados
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• Belize
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• Bermuda
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• Central African Republic
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• China
• Christmas Island
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• Congo, The Democratic Republic of the
• Cook Islands
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• Cote D"Ivoire
• Croatia
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• Czech Republic
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• Djibouti
• Dominica
• Dominican Republic
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• El Salvador
• Equatorial Guinea
• Eritrea
• Estonia
• Ethiopia
• Falkland Islands (Malvinas)
• Faroe Islands
• Fiji
• Finland
• France
• French Guiana
• French Polynesia
• French Southern Territories
• Gabon
• Gambia
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• Germany
• Ghana
• Gibraltar
• Greece
• Greenland
• Grenada
• Guadeloupe
• Guam
• Guatemala
• Guernsey
• Guinea
• Guinea-Bissau
• Guyana
• Haiti
• Heard Island and McDonald Islands
• Holy See (Vatican City State)
• Honduras
• Hong Kong
• Hungary
• Iceland
• India
• Indonesia
• Iran, Islamic Republic Of
• Iraq
• Ireland
• Isle of Man
• Israel
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• Jamaica
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• Kiribati
• Korea People's Democratic Republic
• Republic of Korea
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• Luxembourg
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• North Macedonia
• Madagascar
• Malawi
• Malaysia
• Maldives
• Mali
• Malta
• Marshall Islands
• Martinique
• Mauritania
• Mauritius
• Mayotte
• Mexico
• Federated States of Micronesia
• Moldova, Republic of
• Monaco
• Mongolia
• Montenegro
• Montserrat
• Morocco
• Mozambique
• Myanmar
• Namibia
• Nauru
• Nepal
• Netherlands
• New Caledonia
• New Zealand
• Nicaragua
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• Nigeria
• Niue
• Norfolk Island
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• Norway
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• Palestinian Territory, Occupied
• Panama
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• Paraguay
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• Philippines
• Pitcairn
• Poland
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• Puerto Rico
• Qatar
• Reunion
• Romania
• Russian Federation
• Rwanda
• Saint Helena
• Saint Kitts and Nevis
• Saint Lucia
• Saint Pierre and Miquelon
• Saint Vincent and the Grenadines
• Samoa
• San Marino
• Sao Tome and Principe
• Saudi Arabia
• Senegal
• Serbia
• Seychelles
• Sierra Leone
• Singapore
• Slovakia
• Slovenia
• Solomon Islands
• Somalia
• South Africa
• South Georgia and the South Sandwich Islands
• Spain
• Sri Lanka
• Sudan
• Suriname
• Svalbard and Jan Mayen
• Eswatini
• Sweden
• Switzerland
• Syrian Arab Republic
• Taiwan
• Tajikistan
• Tanzania, United Republic of
• Thailand
• Timor-Leste
• Togo
• Tokelau
• Tonga
• Trinidad and Tobago
• Tunisia
• Turkey
• Turkmenistan
• Turks and Caicos Islands
• Tuvalu
• Uganda
• UK
• Ukraine
• United Arab Emirates
• United States
• United States Minor Outlying Islands
• Uruguay
• Uzbekistan
• Vanuatu
• Venezuela
• Vietnam
• Virgin Islands, British
• Virgin Islands, U.S.
• Wallis and Futuna
• Western Sahara
• Yemen
• Zambia
• Zimbabwe
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Date of birth *

Childs age *

1. How old is your child?

• A) 0-3 years B) 4-7 years C) 8-12 years D) 13 years or older
• B) 4-7 years C) 8-12 years D) 13 years or older
• C) 8-12 years
• D) 13 years or older
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Relationship *

2. How are you related to the child with ASD?

• Mother
• Father
• Grandparent
• Sibling
• Caregiver
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Emotional State *

3. Are you currently experiencing emotional turmoil related to the diagnosis?

• Yes, very much
• Somewhat
• Not really
• Not at all
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Facing new realty *

4. Do you feel overwhelmed by the new realities of your child's diagnosis? o A) Yes, very overwhelmed

• Si, muy abrumada/o tode el tiempo
• A veces
• Raramente
• Para nada
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Diagnosis time  *

5. When did you first learn about your child's autism diagnosis?

• Less than 6 months ago
• 6 months to 1 year ago
• 1-2 years ago
• More than 2 years ago
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Spiritual growth interest *

6. Are you interested in learning spiritual tools to help regulate and understand your emotions?

• Muy interesado(a)
• Algo interesado (a)
• Poco interesado(a)
• NNada interesado(a ) ot interested at all
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Preferred learning styles *

8. Would you prefer to take this course independently or as part of a support group?

• Independently
• As part of a support group
• Combination
• No preference
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Expectations *

9. What outcomes are you hoping to achieve by taking this course?

• Regulación emocional
• Crecimiento espiritual
• Apoyo personal
• Todos los anteriores
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Commitment level *

10. Are you willing to dedicate two hours per week to learn emotional regulation tools?

• Sí, definitivamente
• Tal vez
• Necesito más información
• No estoy seguro(a)
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Commitment Level *

Are you willing to dedicate two hours per week to learn emotional regulation tools?

• Yes, definitely
• Maybe
• Need more information
• Not sure
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