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Accessibility Tools
Home
About Us
UCF Board Members
Junior Board Members
Press
>
Unicorn In the News
Press Releases
Programs
Boca School for Autism
Evolution and Past Programs
Get Involved
Attend an Event
>
2023 Walk the Walk
Your Chance to Win!
Support Boca School for Autism
Supporters
>
Community Partners
Visionary Society and Order of the Unicorn
Contact
Accessibility Tools
Program Participant
Survey
*
Indicates required field
Name
*
First
Last
Email
*
Cell Phone Number
*
Which of the following programs have you participated in? (Check all that apply)
*
Early Start Denver Model (P-ESDM) Autism Scholarship
Mobile Developmental Clinic
Respite Education & Support Tools (REST) Companion Training
Unicorn Children's Foundation Clinics at NSU
Creating Compassionate Children
Special Needs Advisory Coalition Palm Beach County (SNAC PBC)
Unicorn Junior Board
Unicorn Village Academy
Pre-Employment Internship Program
Unicorn Job Club
Unicorn Connection Hub (Virtual Classes)
Unicorn Connection Center Programs
Virtual Hub (specialneedspbc.info)
Special Percs Café/Barista Training
Uniquely Gifted Boutique (Etsy)
Conference/Workshops
Art Studio Classes
Unicorn Connection Club
1. Tell us a little bit about yourself.
*
2. What was your life like before you began participating in Unicorn programs? What was the biggest challenge you were facing?
*
3. What led you to get involved with Unicorn programs?
*
4. Describe some of the activities that you have participated in at Unicorn or services you have received.
*
5. How have these activities or services made a difference in your life? Or now that you have gone through the program, what’s your life like?
*
6. What is your outlook for the future?
*
7. Is there an achievement that you are most proud of?
*
8. Tell me about some of the people you met while participating in Unicorn program.
*
9. Do you plan to continue participating in Unicorn programs?
*
10. What would you say to someone who was considering joining a Unicorn program?
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11. What do you wish other people knew about the Unicorn program you participated in?
*
12. Is there anything else you would like to share with Unicorn?
*
Consent Form
We would like to assess the impact of your participation in our activities and services by making audio or video recordings of your stories. Through this assessment, our organization will learn what worked and what did not work and why. This learning will help us improve our programs and services.
We may also use the products of our assessments to share the stories we collect with our community and other stakeholders or to advocate for our clients' needs. We may use these products to publish our accomplishments and to seek support for our ongoing services, program(s), and/or activities. We may publish information, stories, photographs and artwork through various media-including but not limited to print, electronic and audio-video recordings. Examples of these publications may include but are not limited to newsletters, brochures, reports, Web sites, slideshows, PowerPoint presentations, program photo albums and/or audio-visual public service announcements.
No media shall be used for exploitation or promotion of activities unrelated to the mission of Unicorn Children's Foundation.
Date of Birth
*
Today's Date
*
I grant permission to share my story on social media and newsletters
*
I GIVE Unicorn Children's Foundation permission to publish my name/child's name, image, written work and/or artwork for the purposes stated above.
I DO NOT GIVE permission to publish my name/child's name, image, written work and/or artwork for the purposes stated above.
Digital Signature (Type your name)
*
Upload Headshot (For use on social media and newsletters)
*
Max file size: 20MB
Submit
