The Network on Employment
Burlington, VT 05405
ph: 802-656-1345
vermonta
Local Coordinators
Barre, VT
Bonnie Roberts
United Employment Services/CDS
23 Summer Street
Barre, VT 05641
(802) 476-6339
bonnier@wcmhs.org
Bennington, VT
Michelle Stevens
United Counseling Services of Bennington County, Inc.
Employment Connections
100 LedgeHill Drive, P.O. Box 588
Bennington, VT 05201
(802) 442-5491, Ext. 253
mstevens@ucsvt.org
Middlebury, VT
Dianne Chandler
Employment Associates/CSAC
61 Court Street
Middlebury, VT 05753
(802) 388-3488
Dchandler@csac-vt.org
Rutland, VT
Jenni G. Brileya
Vocational Opportunity Works!
7 Court Square
Rutland, VT 05701
(802) 786-4935
jgbrileya@rmhsccn.org
St. Johnsbury, VT
Robin Boutin
VABIR Rep
Division of Voc Rehab
67 Eastern Avenue, Suite 3
St. Johnsbury, VT 05819
802-748-2771
Springfield, VT
Kim Carroll
Employment Services of HCRS
118 Park Street
Springfield, VT 05156
(802) 885-5170
Kcarroll@hcrs.org
Mentee Application
Mentee Name (or initials):
Professional or School Contact Person (if applicable):
Address:
Phone:
Email:
Dates and times that would work best:
Career Interests (describe one or more jobs/careers that interest you and explain why):
1.
2.
3.
Please indicate whether you will require any accommodations at any point during the day:
APPLICANT CONSENT & PHOTO RELEASE
I would like to participate as a mentee in the Disability Mentoring Day activities in October 2007. I understand every effort will be made to match me with a mentor. I understand that I will be responsible for my own transportation to and from all Disability Mentoring Day events and the mentor site to which I am assigned.
I understand that Disability Mentoring Day can attract attention from the media and that it is used to promote ongoing partnerships between schools, disability organizations and employers. I hereby grant permission to be photographed for promotional and educational purposes.
_______________________________________________
Signature of Applicant and Date
_______________________________________________
Consent of Parent or Guardian (if participant is a minor) and Date
Please return to your local DMD Coordinator.
Burlington, VT 05405
ph: 802-656-1345
vermonta