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
11-164A Pre-ETS Service Identification (Pre-Employment Transition Services (Pre-ETS) Division of Vocational Rehabilitation)
11-164 Community Rehabilitation Program (CRP) Services and Qualifications (Division of Vocational Rehabilitation)
11-163 Applicant Certification and Assurances (Division of Vocational Rehabilitation)
11-154 Personal Pathway
11-153 Governor's Opportunity for Supportive Housing (GOSH) Referral (Home and Community Services)
11-152 Forensic Navigator to Inpatient - Referral Information Form (RIF) (Office of Forensic Mental Health Services)
11-149 Division of Vocational Rehabilitation (DVR) Customer Job Seeker Accommodation Worksheet
11-146 Supported Employment Referral (Economic Services Administration)
11-142 Service Delivery Outcome Plan: Pre-ETS IL Skills Training
11-134 Checklist to Determine Eligibility for Level 4 and/or Deafblind CRP Services (Division of Vocational Rehabilitation)
11-133 Jobs and Training Inventory (Division of Vocational Rehabilitation)
11-132 90 Day Review (Division of Vocational Rehabilitation)
11-130 Residential Support Waiver (RSW) Expanded Behavior Supports (EBS) Eligibility Determination (Home and Community Services)
11-125 Service Delivery Outcome Plan: WBL - Experience C
11-124 Service Delivery Outcome Plan: WBL - Experience B
11-123 Service Delivery Outcome Plan: WBL - Experience A
11-121 Enhanced Case Management Referral Consideration (Developmental Disabilities Administration)
11-119 Informational Interview Worksheet (Division of Vocational Rehabilitation)
11-118 Individualized Plan for Employment (IPE) Worksheet (Division of Vocational Rehabilitation)
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))