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FSU Center for Autism and Related Disabilities (CARD)

Referral/Intake

Referral/Intake Child

Thank you for visiting the Center for Autism and Related Disabilities (CARD) online referral site. CARD is a state funded agency whose purpose is to serve individuals with Autism Spectrum Disorder (ASD) or Related Disabilities, their families, schools, and community. While CARD is able to provide a variety of supports to clients and families, CARD does NOT provide evaluations, diagnoses, therapies, or respite care.

All of CARD services are FREE of charge. Please fill out this referral form as completely as possible. You can save this form and come back later if you cannot complete it at this time. You will be asked to create a login so that you can return. Once the form is complete you can submit to CARD for review.
You will be contacted by CARD staff when your referral form has been received.

Please note: Your information will remain confidential to the extent allowed by Federal and State laws. All personal information provided is exempt from the Florida Sunshine Law.

For more information, please see our website: fsucard.com

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Referral for


Parent/Guardian
** PLEASE INCLUDE GUARDIANSHIP DOCUMENTATION **
Mail Upload Fax Under the age of six without a diagnosis


Parent/Guardian (if different)


Diagnosis
** A COPY OF AN EVALUATION REPORT DOCUMENTING DIAGNOSIS IS REQUIRED **
Mail Upload Fax Under the age of six without a diagnosis


Health


Employment (if applicable)


School (if applicable)
 


Other
Communication
Challenging behavior(s)
Education/School/Academic related
Employment
Housing
Toilet training
Seeking a diagnosis
Social skills/Interaction
Understanding autism spectrum disorder
Other


Home
School
Community
Work
Other


Agency for Persons with Disabilities (APD)
Child Care Assistance
Disability Benefits like SSI (Supplementary Security Income)
Early Intervention for your Infant or Toddler
Food stamps (SNAP)
Group Home/Intermediate Care Facility (ICF)/Institutional Care
Head Start or Early Head Start
Housing Assistance
Medicaid
Phone or Fuel Assistance
TANF (Temporary Assistance for Needy Families)
Unemployment
Visiting Nurse or other Home Visiting like Healthy Families
WIC (Women, Infants, & Children Nutrition Program)
Other


Were you referred to CARD? If so, by whom?


Create Login if you plan to return to form

If you cannot complete the entire form all at once, you can create a login so that you can save the form to complete later.

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(Must be at least 8 characters long and have at least one number and one upper case letter.)