Electronic DSHS Forms

You may download some DSHS forms. These are provided only if a DSHS program requests forms to be available electronically for public use. DSHS forms are available for electronic completion in different software; however, all DSHS forms below are available as Adobe Acrobat PDF files. This means you can open, view, and print each form. To open, view, and print PDF forms, you need to download the free Adobe Acrobat Reader.

We do our best to ensure the links below are accurate; but, if you find a link which does not work, please contact Forms and Records Management.

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Number(asc) Form Name File Format
11-114 Pre-ETS Student Sign-In Roster (Division of Vocational Rehabilitation)
11-112A Service Delivery Outcome Plan (SDOP) Job Shadow (Division of Vocational Rehabilitation)
11-112 Service Delivery Outcome Plan: Job Shadow - Pre-ETS (Pre-Employment Transition Services) (Division of Vocational Rehabilitation)
11-110A Service Delivery Outcome Plan (SDOP): Informational Interview (Division of Vocational Rehabilitation)
11-110 Service Delivery Outcome Plan (SDOP): Informational Interview Pre-ETS (Pre-Employment Transition Services) (Division of Vocational Rehabilitation)
11-106 Service Delivery Outcome Plan (SDOP): IL Pre-ETS (Pre-Employment Transition Services) Self-Advocacy Training (Division of Vocational Rehabilitation))
11-098 Vocational Assessment Worksheet
11-097 Service Delivery Outcome Report: IL (Independent Living Services) (Division of Vocational Rehabilitation)
11-088 DVR, DSB, and PIHE Student Accommodation Cost Share Worksheet
11-084 Contracted Employee(s) to Provide IL Services and Service(s) Approved (Division of Vocational Rehabilitation)
11-071 DVR Employer Expense Worksheet (Division of Vocational Rehabilitation)
11-070 DVR Attendance Log and Billing Invoice (Division of Vocational Rehabilitation)
11-069 DVR Internship Agreement (Division of Vocational Rehabilitation)
11-068 Customer Internship Program Internship Application (Division of Vocational Rehabilitation)
11-067 Monthly Budget Worksheet (Division of Vocational Rehabilitation)
11-066 Assistive Communication Technology Request (Office of Deaf and Hard of Hearing)
11-058 Trial Work Experience (TWE) Agreement (Division of Vocational Rehabilitation)
11-034B Basic Food Eligibility Requirements: What You Need to Know
11-030 Service Delivery Outcome Report (SDOR) (Division of Vocational Rehabilitation)
11-022 Application for Vocational Rehabilitation Services
10-720 Certified Children’s Residential Services Initial Application (Developmental Disabilities Administration)
10-717 Assisted Living Facility Staff Interview - Attachment F (Residential Care Services)
10-713 Nursing Care Consultant (NCC) Focused Assessment (Developmental Disabilities Administration)
10-711 Adult Family Homes Program Training Plan (Residential Care Services)
10-709 Request for Residential Habilitation for Dependent Youth Services (Developmental Disabilities Administration)