Vermont APSE:

The Network on Employment

Burlington, VT 05405
ph: 802-656-1345

-mentees

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 

Robin.Boutin@dail.state.vt.us

 

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.

 

 

  Copyright Vermont APSE, 2007, VT-APSE Logo by J. Whalen. All rights reserved.

Burlington, VT 05405
ph: 802-656-1345