"Referral for Services" - Delaware

Referral for Services is a legal document that was released by the Delaware Department of Labor - a government authority operating within Delaware.

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  • Released on August 1, 2019;
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Clear Form
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
252 Chapman Road, Christiana Building, Suite 210, Newark, DE 19702
Fax:
302-368-6988
Div. of Vocational Rehabilitation, ATTN: Middletown Office
Phone: 302-696-3180
Appoquinimink State Service Ctr., 122 Silver Lake 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
Fax:
302-856-5486
8 Georgetown Plaza, Suite 2, Georgetown, DE 19947
Rev. 2019/08
Clear Form
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
252 Chapman Road, Christiana Building, Suite 210, Newark, DE 19702
Fax:
302-368-6988
Div. of Vocational Rehabilitation, ATTN: Middletown Office
Phone: 302-696-3180
Appoquinimink State Service Ctr., 122 Silver Lake 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
Fax:
302-856-5486
8 Georgetown Plaza, Suite 2, Georgetown, DE 19947
Rev. 2019/08