Vocational Rehabilitation - Nevada Department of Employment, Training and Rehabilitation

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.

Vocational Rehabilitation Form

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

Yes No

Are you your own legal guardian?*

Yes No

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

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

Yes No

What high school do you attend?*

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

Yes No

Were you referred by Job Connect/One Stop?*

Yes No

If yes, in which city or on what street?

Do you want a “virtual” appointment or in-person appointment?*

Virtual In-Person

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.

Vocational Rehabilitation Form

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