Neurodiversity Group – New Jersey Lawyers Assistance Program

Neurodiversity Group

Please fill out this questionnaire to set up a meeting with group facilitators in order to join the group.

Please select your position in the New Jersey legal community.

If you selected other as your position in community you can describe:

Name *

First

Last *

Last

Pronouns, please select… Pronouns, please select…

If other pronouns, please provide

Email Address *

Best Method to reach me is: (Please select)

Mobile Phone Number

Home Phone

Work Phone

Mailing Street

City

State

Zip Code

County

If you are human, leave this field blank.