Form DVR-1 "Referral for Services" - Delaware

What Is Form DVR-1?

This is a legal form that was released by the Delaware Department of Labor - a government authority operating within Delaware. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on October 1, 2016;
  • The latest edition provided by the Delaware Department of Labor;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form DVR-1 by clicking the link below or browse more documents and templates provided by the Delaware Department of Labor.

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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