Vocational Rehabilitation - Nevada Department of Employment, Training and Rehabilitation

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Thank you for your interest in applying for the services offered by the State of Nevada, Bureau of Vocational Rehabilitation or Bureau of Services to Persons Who are Blind or Visually Impaired. If you need assistance in filling out this form, please call (702) 486-0388 in Southern Nevada; (775) 823-8112 in Northern Nevada; or TTY number at (775) 687-5353. Otherwise, please proceed in completing the form. After you complete this form an application will be emailed to you at the email address you provide on this form. Please note: the email containing the application will be from a DocuSign email address, providing the opportunity to complete and sign your application digitally from your computer, tablet or smart phone.

Vocational Rehabilitation Form

Are you a minor or under the age of 18?*

Yes No

This field is required.

Are you your own legal guardian?*

Yes No

This field is required.

If no, please provide legal guardian's email address:

Are you still in high school or are a recent
graduate?*

Yes No

This field is required.

What high school do you attend?*

Are you seeking a sub-minimum wage certificate to work in sheltered employment?*

Yes No

This field is required.

Were you referred by Job Connect/One Stop?*

Yes No

This field is required.

If yes, in which city or on what street?

Your Name*

Your Email Address*

List any needed accommodation here

If you have any questions about applying, please call: (775) 823-8112 if in the Northern part of the state or (702) 486-0388 if in the Southern part of the state.

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