School Contract Request / Change Form

Welcome to the SD Associates Contract Request for Northern Vermont School and Clinic-Based Services. If you’re interested in FUV services, please email: windsor.admin@sdplus.org

Please fill out all fields in the form below. If you have questions, you can leave them in the last box titled ‘Additional notes’. After submitting, a director will be in touch within one business day to answer any questions and confirm the fulfillment of your request.

What type of request is this? (Please select one)

New contract for the 21-22 school yearContract change for the 21-22 school year

Hours you would like to contract with SD for program services delivered by a Behavior Instructor supervised by a Behavior Analyst:

Three spaces per day are provided in the event you need services in 3 different locations in a single day. Please input the total number of hours per day per location.

Monday
   
   
   

Tuesday
   
   
   

Wednesday
   
   
   

Thursday
   
   
   

Friday
   
   
   

For clients that are served in either an SD location or solely remotely we can provide Special Education Services. This is not available for students who are served in a hybrid model in their sending school and remotely. We also can not supplement Speech and Language Services or Special Education services being received by a school provider at this time.

Transportation (Please select one)

School or parent will be providing transportationWe are requesting transportation from Sd services

Please initial after each of the following 3 items to confirm you have read and understood the information they contain.