Direct Support Certification Registration

Name

This field is for validation purposes and should be left unchanged.

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

E-mail*

Phone*

Employer/Company

How did you hear about Direct Support Certification?

Please check a category that best describes you.*

I would like to apply for a scholarship.*

Yes
No

Scholarship Application

AuSM is committed to equity in our programming by providing scholarship opportunities for participants who face barriers to participation. Scholarships are provided as discounts for fee-based programs not covered by disability waivers. Scholarships are only available to Minnesota residents. While we ask for your mailing address (above), AuSM will never ask for your immigration status. We strongly encourage individuals from historically marginalized communities to apply. To be eligible for a scholarship, you must live in Minnesota.

I am...*

Autistic
Low Income
Black, Indigenous, and People of Color (BIPOC)
LGBTQIA+
Rural Minnesota Resident
None of the Above

Please select all that apply.

You are not eligible for the scholarship rate. Please select a different rate.

AuSM offers a reduced rate to improve the accessibility of our workshops for our larger community. Please answer these questions to determine if you are eligible for the reduced rate.

Household Income:*

Household Size*

Low Income is defined as household income less than 100% of the Federal Poverty Guidelines (a single person earning less than $15,650, increasing by $5,500 for each additional person).

County*

Rural Minnesota is defined as any Minnesota county other than Anoka, Carver, Dakota, Hennepin, Ramsey, Scott, and Washington counties.

Payment

By registering for an AuSM class, you agree to pay in full any amount not covered by the third party payer. You may also apply for a scholarship in this section.

Direct Support Certification*

Direct Support Certification ($299.00)
Direct Support Certification - Scholarship Rate ($149.50)

You are not eligible for the scholarship rate. Please select a different rate.

Would you like to add a donation to the Autism Society of Minnesota?

Yes
No

Donation Amount:*

Total

$0.00

How would you like to pay?*

Third party payer
Pay now

Third Party Payer Organization Name*

By completing this form, you agree to pay in full any amount not covered by the Third Party Payer.

Third Party Payer Contact Name*

First Last

Third Party Payer Contact Email*

Third Party Payer Contact Phone*

My billing address is the same as my mailing address.

Yes

Billing Address*

Street Address Address Line 2 City State ZIP Code

Credit Card*

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

CAPTCHA

Direct Support Certification Registration

2026 Autism Direct Support Certification Registration

Scholarship Application

You are not eligible for the scholarship rate. Please select a different rate.

Payment

You are not eligible for the scholarship rate. Please select a different rate.