Program Application

Founding Partner Application

Practice / organization name *

Your name (primary contact) *

Email *

Phone

Website

Location (City, State - or 'Online / National') *

What kind of ND-focused practice or organization are you? *- Select -Therapy practiceIEP advocateWellness practitionerCoaching practiceND-focused nonprofitOther ND-focused organization

Who do you serve, and how? *

Tell us about your credentials, licenses, or certifications relevant to your services. *

What services would you offer through the marketplace? *

How long have you been doing this work?- Select -Under 1 year1-3 years3-5 years5-10 years10+ years

Why do you want to be an ND Collab Founding Partner? *

Our four values are Presume Intelligence, Amplify ND Voices, Collaboration, and Always Learning. Which resonates most with you, and how does your work reflect it? *

How does your practice affirm and support neurodivergent people? *

Short public bio for your Founding Partner listing (this appears on your profile) *

What do you offer? List a few services, specialties, or topics (e.g. autism therapy, IEP advocacy, feeding therapy, parent coaching) so members can find you in the Smart Guide search. *

Link to your logo or a photo (paste a URL - you can also send it to us later)

I understand I'll complete the free Partner & Affiliate Certification course before going live.

I understand Founding Partner status includes a values and credentialing review.

I understand payout and tax details are set up securely in the affiliate system after approval, not on this form.

I've read and agree to represent ND Collab in line with its values and the code of conduct covered in the certification.

I have read and agree to the ND Collab Partner & Affiliate Agreement. Read the agreement »

Digital signature (type your full name) *

It's okay to contact me about my application.

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