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NDU Inquiry Form

Full Name

*

Email Address

*

Organization / Institution (if applicable)

Which best describes you?

*

Which best describes you?

A

I represent a college or educational institution

B

I represent an organization, business, or team

C

I am an individual or family seeking support

Institution / College Inquiry

What type of institution are you?

*

What type of institution are you?

A

Community college

B

Four-year college or university

C

Technical / trade school

D

Other

Which departments are involved?

*

Which departments are involved?

Disability Services

Student Success / Retention

Advising

TRIO / First-Gen

Counseling / Wellness

Administration

Other

What is your primary concern right now?

*

What is your primary concern right now?

ND student retention

Academic probation / failure cycles

Accommodation breakdowns

Executive function challenges

Student mental health / burnout

Staff capacity / overload

Grant-funded or pilot programming

What kind of support are you exploring?

*

What kind of support are you exploring?

A

Student programs

B

Staff training

C

Case consultation

D

Pilot / partnership

Anything you’d like us to know about your context?

How did you hear about Neurodivergent Uprising?

*

How did you hear about Neurodivergent Uprising?

A

Google

B

ChatGPT / AI

C

Referral

D

Social media

E

Workshop / talk

“What would make support feel most helpful right now?

*

Organization / Business Inquiry

What best describes your organization?

*

What best describes your organization?

A

Startup or small business

B

Creative / media / agency

C

Tech / product team

D

Nonprofit

E

Solo founder / self-employed

F

Other

What challenges are you seeing?

*

What challenges are you seeing?

Burnout

Turnover

Focus / follow-through issues

ND leadership or staff needs

Communication breakdowns

Overwhelm / overload

Team conflict

Who is most affected?

*

Who is most affected?

A

Founders

B

Leadership

C

Team members

D

Creative staff

E

Myself (solo/self-employed)

What kind of support are you exploring?

*

What kind of support are you exploring?

A

Team / leadership training

B

Workflow redesign

C

Burnout prevention

D

ND workplace support

E

Consulting

F

Not sure yet

Briefly describe what’s happening.

*

How did you hear about Neurodivergent Uprising?

*

How did you hear about Neurodivergent Uprising?

A

Google

B

ChatGPT / AI

C

Referral

D

Social media

E

Workshop / talk

“What would make support feel most helpful right now?

*

Individual / Family Inquiry

Who are you seeking support for?

*

Who are you seeking support for?

A

Myself

B

My Child

C

My Family

D

A college/graduate student

“What are you dealing with right now?

*

“What are you dealing with right now?

Executive function struggles

Burnout / overwhelm

School or IEP issues

College challenges

Parenting while ND

Work or career issues

Not sure

What kind of support are you looking for?

*

What kind of support are you looking for?

A

1:1 support

B

School advocacy

C

Coaching

D

Resources / tools

E

Community

F

Not sure yet

“Anything you’d like us to know?”

How did you hear about Neurodivergent Uprising?

*

How did you hear about Neurodivergent Uprising?

A

Google

B

ChatGPT / AI

C

Referral

D

Social media

E

Workshop / talk

“What would make support feel most helpful right now?

*