<<DVRSSA-1365.pdf>> 

Hi,

During the recent Vermont Interactive Television Conference on the
Ticket To Work we said we would send you the attached SSA Form 1365.  We
want you to have the tools you need to effectively partner with
consumers and VR Counselors as you work the TTW process together.  The
attached is the form that needs to be filled out, signed (by both the
individual and the VR counselor), and faxed to Cecile Sherburn to
document assignment of an individual's ticket to VR (and our EN
partner).

If the form is filled out electronically, it needs to be printed,
signed, and faxed to Cecile for processing.

Our hope is that providing you a copy of this form will expedite the
process with our joint consumer customers.

Let me know of any questions you may have,
Jerry

Cecile's contact information:

Cecile R. Sherburn
Ticket To Work Coordinator & VR Administrative Assistant 
Vocational Rehabilitation of Vermont
Weeks 1A 
103 S Main St
Waterbury, VT 05671-2303
Phone: 1-802-241-2447 v/tty
Toll Free: 1-800-361-1239
Fax: 1-802-241-3359
Email: [log in to unmask]

Jerry Wood

Supported Employment Coordinator
VocRehab Vermont
103 South Main Street, Weeks 1A
Waterbury, Vt 05671-2303
[log in to unmask]
802-241-2195

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