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Rehabilitation Division

Forms and Documents

  • Applications for Vocational Rehabilitation
  • Nevada State Rehabilitation Council Annual Report
  • State Plan
  • Nevada State Needs Assessment Powerpoint Presentation
  • Client Satisfaction Surveys
  • Job Developer Forms
Form or Document Name Format(s)
Applications for Vocational Rehabilitation:
Vocational Rehabilitation Services Application* Excel | PDF
Vocational Rehabilitation Services Application Large Print* Excel | PDF
Vocational Rehabilitation Services Application in Spanish*
(Solicitud de servicio de rehabilitacion profesional)
PDF
*Note: Applications can only be accepted in person. (Vocational Rehabilitation Locations)
If you require any assistance in completing the application, a counselor or technician can assist you.
Older Individuals Who Are Blind Program Application Word
Nevada State Rehabilitation Council Annual Report:
Annual Report 2018 PDF
Annual Report 2017 PDF
Annual Report 2016 PDF
Nevada State Plan:
FFY 2019 State Plan Word | PDF
FFY 2015 State Plan Word | PDF
FFY 2014 State Plan PDF
FFY 2013 State Plan Word | PDF
Nevada State Needs Assessment Powerpoint Presentation:
Nevada Statewide Needs Assessment PPT | PDF
Client Satisfaction Surveys:
FFY 2019 Satisfaction Survey Report PDF
FFY 2016 Satisfaction Survey Report PDF
FFY 2015 Satisfaction Survey Report PDF
REQUIRED Job Developer Forms:
CBA Agreement PDF
Job Development Services Intake Accept/Reject Word | PDF
Job Placement Plan Checklist Word | PDF
Job Placement Services Report Word | PDF
Job Placement Plan Word | PDF
PETS Attendance Sheet PDF
PETS Student Tracking Summary PDF
PETS Training Evaluation PDF
PETS Training Report PDF
PETS Training Weekly Report PDF
Verification of Employment Word | PDF
30,60,90 Day Verification of Vocational Rehabilitation Word | PDF
SAMPLE Job Developer Forms:
CBA Accept / Reject Report PDF
CBA Final Exit Summary Report PDF
CBA Job Duties PDF
CBA Supervisor Weekly Report PDF

Southern Nevada
Phone:(702) 486-5230
TTY:(800) 326-6868

Northern Nevada
Phone:(775) 687-6860
TTY:(775) 684-8400