Contact Information:
Last Name
First Name *
Preferred Name
School ID *
Email Address
Cell Phone Number
Cell Phone Opt Out

 Academic Information:
College
Campus
Program Entry Grade Level

Qualification Information

    Do you have one of the folloiwng following disabilities? (diagnosed, self-diagnosed, or in process of seeking diagnosis)

  • Autism/ASD
  • ADHD
  • Specific Learning Disability
  • Tourette's
  •  Other
Do you have...

Accommodations

    If yes, have you applied to Student Accessibility and Inclusive Learning Services for accommodations?
Registration status:
Support Needed
What Executive Function areas would you like help with? (please check all that apply)
Time Management
Organization
Decision Making
Planning
Adaptability
Self Regulation
Other

How Can We Help?

    What are you hoping to gain from the GATE program? 
What else do you need?