VR’s STAR & Transition Youth Program
Provider Choice Acknowledgement
I, ______________________________________ (parent/guardian name
for minors) give my consent for Mega Social Enterprise & Mega Enrichment
Academy dba for Ella and Rosa Safe Haven and Care Inc. to provide STAR,
Transition Youth Program (Pre-ETS), and/or Vocational Services to
myself or my child_________________________ (minor name).
I am aware that other vendors in the area may also provide a similar/same
service(s) but I have chosen Mega Social Enterprise & Mega Enrichment
Academy Inc.
My signature acknowledges that I am aware that Mega Social Enterprise &
Mega Enrichment Academy Inc. will contact the necessary personnel
(Parent, Guardian, School, School Board, Department of Education/Division
of Vocational Rehabilitation) in order to provide services.
___________________________________________ _______________________________
Signature of Student Date Signed
___________________________________________ _______________________________
Signature of Parent/Guardian (optional for 18&up) Date Signed
___________________________________________ ________________________________
Signature of Witness Date Signed
Note: Each youth & adult have the choice to pick or not pick any STAR or Transition Youth services
that they desire. They also have a choice to pick any VR vendor. Please visit VR Service Provider
Choice Directory at https://choicedirectory.rehabworks.org/ for other Vendor options if you desire.
Please know services, training schedules, sites, and incentives vary between vendors. Assistance is
available with this step if needed.
Office Use Only
School: School Board: Local VR Unit:
Explanation if signature of client or legally responsible person is not obtained:
________________________________________________________________________________________________
________________________________________________________________________________________________
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