OMAHA Volunteer Network

Email Address *

First Name

Last Name

Mailing Address

Street AddressAddress Line 2CityState/Province/RegionPostal / Zip CodeCountry

Phone Number *

Age

I'm over 21
I'm younger than 21

Do you have a connection to autism?

True or False: Only children have autism.

True
False

Which statement is true?

Individuals with autism are all unique.
Individuals with autism are all exactly alike
If the Easter Bunny sees his shadow there will be 6 more weeks of winter.

Which statement is true?

It snows during the summer.
Individiuals with autism may have trouble transitioning from one activity to another. It is helpful to give them a reminder or heads up about changes.
Everyone with autism is exactly like Rainman.

Which statement is true?

A person with autism may not always respond to their name.
Pink elephants can fly.
These are really hard questions.

Which of the following statements is false?

Even though a person with autism can talk they may have trouble explaining how they feel.
Santa Claus is a mean man who wears a green lizard skin suit.
An individual with autism may be over or under sensitive to touch, movement, sights or sounds.

Any Felony Convictions?

I have been convicted of a felony.
I have never been convicted of a felony.

Any Misdemeanor convictions?

I have been convicted of any misdemeanor involving child health, child welfare or drugs?
I have never been convicted of any misdemeanor involving child health, child welfare or drugs.

The Autism Society of Nebraska will not deny volunteer placement to any applicant solely because the person has been convicted of a crime. The Autism Society of Nebraska however, may consider the nature, date and circumstances of the offense as well as wh

Please explain any convictions.

AUTISM SOCIETY OF NEBRASKA Omaha Volunteer Network

AUTISM SOCIETY OF NEBRASKA
Omaha Volunteer Network