Open to young adults ages 18 – 24 with intellectual and/or developmental disabilities.

Dates: October 19th – 22nd
Times: 1:00pm – 4:00pm

Friendships and Dating Application

Attendee Registration:

*Note: Information and questionnaire to be completed by the attendee participating in the classes. All classes are in-person only for ages 18-24 years old.

Attendee First Name 

Attendee Last Name

Attendee Birthdate

Attendee Email

Attendee Mobile Phone

Best way to contact you?

PhoneTextEmail

Best time to contact you?

Mailing Street 

City

State

Please select... AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY PR AB BC MB NB NL NT NU ON PE QC SK YT

Postal Code

Borough/Region 

Please select... Aleutians East Aleutians West Anchorage Bethel Bristol Bay Denali Dillingham Fairbanks North Star Haines Juneau Kenai Peninsula Ketchikan Gateway Kodiak Island Lake And Peninsula Matanuska Susitna Nome North Slope Northwest Arctic Prince Wales Ketchikan Sitka Skagway Hoonah Angoon Southeast Fairbanks Valdez Cordova Wade Hampton Wrangell Petersburg Yakutat Yukon Koyukuk

Sex  

MaleFemale

Race

American Indian or Alaska NativeAsianBlack or African AmericanPacific IslanderWhiteSome other racePrefer not to answer

Attendee Questionnaire:

Are you able to attend all in-person classes?

Location: Mat-Su Health Foundation Wellness Room, 777 N. Crusey St. suite B106, Wasilla AK, 99654

Dates: 10/19/26, 10/20/26, 10/21/26, 10/22/26

YesNoMaybe

If maybe, please explain. 

Do you have access to reliable transportation for all in-person classes?

YesNoUnsure

Are you able to read, understand and follow through on written information without assistance?

YesNoUnsure

Do you need any accommodations in order to participate?

YesNo

If yes, what accommodations are helpful/useful/supportive?

What activities do you really enjoy?

What community/transition skills do you have?

CookingPlanningMaking AppointmentsMaking Phone CallsSelf-advocacyCommunicationOther

If other, please list skills. 

Why do you want to be in the class?

Do you use Social Media? What type of Social Media do you use?

Parent/Guardian Information:

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Phone

Parent/Guardian Email  

This information will also be used for Emergency Contact 

*Attendees will be interviewed prior to the start of the classes.

*Individuals who are able to participate must experience developmental disabilities and/or intellectual disabilities.

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