VAMOS Letter of Interest
Complete this form in order to indicate your interest in being selected as a VAMOS participant at Mandy's Farm. Completion of this form does not guarantee registration, as this is determined based on meeting eligibility requirements and available funding. Following your form submission, you will be contacted for further information within five business days.
Please provide the first and last name of the individual completing this form: *
Your answer
Please provide the first and last name of the individual who would like to be considered for participation in the VAMOS Program (the applicant): *
Your answer
Does the VAMOS applicant have a documented intellectual or developmental disability? *
What is the date of birth of the VAMOS applicant? *
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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: *
Your answer
Please provide an email address for us to update the applicant/ their support network regarding their VAMOS status:
Your answer
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