Fall VAMOS Interest Form
Please take a moment to fill out the following form being as specific and detailed as possible. All information is confidential and this information will only be used to support the VAMOS program. 
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Email *
Please provide the first and last name of the individual completing this form: *
Relationship to the applicant:
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If person completing form is not the applicant or parent/guardian, please enter parent/guardian name:
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Please provide the first and last name of the individual who would like to be considered for participation in the VAMOS Program (the applicant)
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Does the VAMOS applicant have a documented intellectual or developmental disability?
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What is the date of birth of the VAMOS applicant? (Applicant must be between the ages of 14-21 at time of participation)
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Does the VAMOS applicant currently receive staffing/ funding supports through the DD or Mi Via Waivers? *
Please provide a phone number for us to update the applicant/ their support network regarding their VAMOS status:
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Please provide an email address for us to update the applicant/ their support network regarding their VAMOS status: (please ensure this email is correct. If an incorrect email is provided, we will not be able to register the participant)
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What is the language preferred by the family and/or VAMOS applicant?
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What session is the applicant interested in attending? (Fall, Spring, Summer?)
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VAMOS funding requires all participants to be attending school. To verify this, we are required to collect applicant's State-Issued Student ID Number (STARS ID). This is different than your School ID number. It can be found at the top of the IEP. Please enter the applicant's 9-digit STARS ID number below.
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What school does the applicant attend?
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