APPLICATION PROCEDURE:

1. Before submitting an application, call the faculty from your discipline or the Training Director,
Jean Beatson, to get more information about the program, answer your questions and ascertain
whether it seems like a good fit for you.
Julianne Nickerson
Jean Beatson
Dorigen Keeney
Marie-Christine Potvin
Stephen Contompasis
Debbie O'Rourke
Peggy Sands
Mary Ellen Seaver-Reid
Jim Calhoun
Mary Alice Favro
Jessica Strolin-Goltzman

Family Support
Training Director/Nursing
Nutrition
Occupational Therapy
Program Director/Pediatrics
Physical Therapy
Physical Therapy
Special Education
Psychology/ASD
Clinical Director/Speech-Language
Social Work Faculty

899-3798
656-4291
865-0255 (ext. 113)
318-0603
656-3187
656-3252
656-0204
656-0204
888-6723
656-1915
656-2173

2. Submit 1 letter of recommendation from faculty/colleague in your discipline addressing:

Discipline-specific expertise including experience with individuals with variety of

neurodevelopmental disabilities or special health needs
Verbal and written communication skills
Leadership experience or potential
Versatility, adaptability & flexibility
Experience working with teams and families

3. Submit 1 letter from one of the following: clinical supervisor, community professional, or a
family member of a child with neurodevelopmental disability or special health needs.
4. Submit a 1-2 page typed essay explaining your reasons for participating in VT-ILEHP,
including any clinical experience related to maternal and child health issues and/or infants,
children and adolescents with neurodevelopmental disabilities and ASD. Highlight your future
leadership goals and how they are compatible with Maternal and Child Health.
5. Submit a copy of your academic transcripts & resume with copy of related professional
development activities. Include phone and email for interview scheduling.
6.

Complete the application form and send all application materials to:
VT-ILEHP Program, attn: kh
University of Vermont
477 RE4, 4318 Rehab, UHC
1 S. Prospect Street
Burlington, VT 05401

APPLICATION FORM
Fellowships/Traineeships
NAME:

________________________________________

DATE OF APPLICATION: ____________________________

DISCIPLINE: ________________________________________
HOME ADDRESS: ________________________________________
________________________________________
________________________________________
PHONE:

(Home) _________________________________
(Work) _________________________________
(Cell) _________________________________

E-MAIL:

________________________________________

EDUCATION: (include all undergraduate & graduate degrees)

Major
Degree
Institution
Year
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
CURRENT POSITION:
______________________________________________________
Please describe your current responsibilities:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
RELATED CLINICAL/PROFESSIONAL EXPERIENCE:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Focus area(s) of interest:

NDD

ASD

MH

Unsure

REFERENCES:
1.
Name: ________________________________________ Phone: __________________
2.

Name: ________________________________________ Phone: ________________