P2P Enrollment Form - Vermont Pathways to Partnerships

Vermont Pathways to Partnerships Project Enrollment

The VT Pathways to Partnerships (VTP2P) project helps young people with disabilities create individualized plans for life after high school by supporting partnerships and training activities between students, P2P project partners and school professionals.

If you would rather complete this form offline, you may download a printable PDF version and submit it via your preferred method.

Is the student younger than 18?(Required)

Yes

Does student have a guardian?(Required)

Yes

If you answered “Yes” to either question, a parent or guardian must complete this form.

Need this form in a different format?
Email: ahs.pathwaystopartnershipsvt@vermont.gov or call Kim at 802-798-9975.

Student Information (All students)

School name(Required)

Grade in school(Required)

Legal first name and middle initial:(Required)

Chosen name (if different):(Required)

Last name:(Required)

Date of birth:(Required)

MM slash DD slash YYYY

Student Contact Information

School email:(Required)

Personal email:(Required)

Cell phone:(Required)

Home phone:(Required)

What is the best way to contact student?(Required)

Parent or Guardian Information (Only for students younger than 18 or who have a guardian.)

Name(Required)

First Last

Email:

Cell phone:(Required)

What is the best way to contact parent or guardian?(Required)

Address(Required)

Street Address: Town/City: State ZIP / Postal Code

By signing this form:

I consent to enroll in the Vermont Pathways to Partnerships Project (VTP2P).
I consent for VTP2P staff to collect information about VTP2P activities I participate in.
I understand this information will be shared with the U.S. Department of Education Rehabilitation Services Administration in a way that does not identify me.
I understand my information will not be shared outside of this project and identified partners.
I understand that my personal information and any data collected will be kept safe according to federal and state privacy laws.
I understand that I may be contacted by the VTP2P team or project partners about program participation and a survey.
I understand that if I, the student, turn 18 while enrolled in the project, I agree to the conditions agreed to here.
I understand I will receive a copy of this enrollment form.

Student Name:(Required)

School:(Required)

This consent will expire on September 30, 2028. I may cancel consent anytime by sending a request to ahs.pathwaystopartnershipsvt@vermont.gov.
If I cancel my consent before the expiration date above, I understand that information I shared about my participation in the program before cancelling may continue to be shared but will not be shared in any way that identifies me.

Student Signature:(Required)

Date(Required)

MM slash DD slash YYYY

Student Signature:

Date

MM slash DD slash YYYY

Parent or Guardian Printed Name:(Required)

Parent/Guardian Signature:(Required)

Date

MM slash DD slash YYYY

Is a representative from your school assisting you with this form?

Yes

For School Use Only

Student PERM#:

We attest this student is on a

504

IEP

Please choose the student's disability designation from the following list:

Primary Disability (Select one):

Intellectual Disability

Speech or Language Impairment

Visual Impairment

Emotional Disturbance

Orthopedic Impairment

Specific Learning Disability

Deaf-Blindness

Multiple Disabilities

Developmental Delay

Traumatic Brain Injury

Autism Spectrum Disorder

Hearing Loss

Intellectual Disability

Speech or Language Impairment

Visual Impairment

Emotional Disturbance

Orthopedic Impairment

Other Health Impairment

Specific Learning Disability

Deaf-Blindness

Multiple Disabilities

Developmental Delay

Traumatic Brain Injury

Autism Spectrum Disorder

Hearing Loss

Completed by:

Title:

Date:

MM slash DD slash YYYY

P2P Project Partners

ReSOURCE, Vermont Association for the Blind and Visually Impaired, HireAbility, Vermont Family Network, Vermont Center for Independent Living, UVM Center on Disability and Community Inclusion, Green Mountain Self Advocates, Division for the Blind and Visually Impaired, Education Services Practice and Deaf Hard of Hearing DeafBlind (ESP), Developmental Disabilities Services Division, VT Agency of Education. The contents of this enrollment form were developed under a grant number H421E230023 from the Department of Education. However, those contents do not necessarily represent the policy of the Department of Education, and you should not assume endorsement by the Federal Government. (Authority: 20 U.S.C. §§ 1221e-3 and 3474) rev. 3/10/2025

What's Next?

There is an online survey for students over 18 and caregivers or guardians for students younger than 18 or who have a guardian.
Your answers will be shared with the VT-P2P Transition Coordinator to help you get started finding the best transition activities for you.
This survey will also be used as part of a research study to see how VT-P2P is working in Vermont and around the United States.
It is your choice to complete the survey or not.

Have questions?

Contact Jesse Suter at 802-656-1130 or jesse.suter@uvm.edu.

Your input matters! After submitting this form, you’ll be redirected to a brief survey to help us improve your experience.