VAMOS Interest Form
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. Following your form submission, you will be contacted for further information.

We are currently accepting interest forms for Fall 2021.

Thank you for being a part of VAMOS!
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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): *
Please provide the first and last name of the individual completing this form: *
Relationship to participant *
If person completing form is not the applicant or parent/guardian, please enter parent/guardian name:
Does the VAMOS applicant have a documented intellectual or developmental disability? *
What is the language preferred by the family and/or VAMOS applicant? *
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? *
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. *
What school does the applicant attend? *
Please provide a phone number for us to update the applicant/ their support network regarding their VAMOS status: *
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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This form was created inside of Mandy's Farm.