Form DVR-1 "Referral for Services" - Delaware

Form DVR-1 is a Delaware Department of Labor form also known as the "Referral For Services". The latest edition of the form was released in October 1, 2016 and is available for digital filing.

Download an up-to-date Form DVR-1 in PDF-format down below or look it up on the Delaware Department of Labor Forms website.

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Download Form DVR-1 "Referral for Services" - Delaware

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State of Delaware
Department of Labor
Date:
Division of Vocational Rehabilitation
REFERRAL FOR SERVICES
This is a confidential communication
Last Name:
First Name:
MI:
Address:
City:
State:
Zip Code:
County:
Alternate Phone Number:
Telephone Number:
Cell Phone Number:
Email Address:
Social Security Number:
Date of Birth:
Age:
Sex:
Female
Male
Disability:
What assistance is required to become employed?
How did you hear about DVR?
Other comments:
Please mail or fax the completed form to the office location nearest you.
Div. of Vocational Rehabilitation, ATTN: Wilmington Office
Phone: 302-761-8275
4425 North Market St., Wilmington, DE 19802
Fax:
302-761-6633
Div. of Vocational Rehabilitation, ATTN: Newark Office
Phone: 302-368-6980
Pencader Corporate Center, 225 Corporate Blvd., Suite 204, Newark, DE 19702
Fax:
302-368-6988
Div. of Vocational Rehabilitation, ATTN: Middletown Office
Phone: 302-696-3180
Appoquinimink State Service Ctr., 122 Silverlake Rd., Middletown, DE 19709
Fax:
302-696-3181
Div. of Vocational Rehabilitation, ATTN: Dover Office
Phone: 302-739-5478
Blue Hen Corporate Center, 655 S. Bay Rd., Suite 2H, Dover, DE 19901
Fax:
302-739-6874
Div. of Vocational Rehabilitation, ATTN: Georgetown Office
Phone: 302-856-5730
8-B Georgetown Plaza, Georgetown, DE 19947
Fax:
302-856-5486
DVR - 1 Rev. 2016/10
State of Delaware
Department of Labor
Date:
Division of Vocational Rehabilitation
REFERRAL FOR SERVICES
This is a confidential communication
Last Name:
First Name:
MI:
Address:
City:
State:
Zip Code:
County:
Alternate Phone Number:
Telephone Number:
Cell Phone Number:
Email Address:
Social Security Number:
Date of Birth:
Age:
Sex:
Female
Male
Disability:
What assistance is required to become employed?
How did you hear about DVR?
Other comments:
Please mail or fax the completed form to the office location nearest you.
Div. of Vocational Rehabilitation, ATTN: Wilmington Office
Phone: 302-761-8275
4425 North Market St., Wilmington, DE 19802
Fax:
302-761-6633
Div. of Vocational Rehabilitation, ATTN: Newark Office
Phone: 302-368-6980
Pencader Corporate Center, 225 Corporate Blvd., Suite 204, Newark, DE 19702
Fax:
302-368-6988
Div. of Vocational Rehabilitation, ATTN: Middletown Office
Phone: 302-696-3180
Appoquinimink State Service Ctr., 122 Silverlake Rd., Middletown, DE 19709
Fax:
302-696-3181
Div. of Vocational Rehabilitation, ATTN: Dover Office
Phone: 302-739-5478
Blue Hen Corporate Center, 655 S. Bay Rd., Suite 2H, Dover, DE 19901
Fax:
302-739-6874
Div. of Vocational Rehabilitation, ATTN: Georgetown Office
Phone: 302-856-5730
8-B Georgetown Plaza, Georgetown, DE 19947
Fax:
302-856-5486
DVR - 1 Rev. 2016/10
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