Electronic DSHS Forms

The Electronic DSHS Forms page is a centralized repository where the public can find and download official forms for Washington Department of Social and Health Services programs.

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.

Number Form Name Form File
11-130 Residential Support Waiver (RSW) Expanded Behavior Supports (EBS) Eligibility Determination (Home and Community Services)
11-132 90 Day Review (Division of Vocational Rehabilitation)
11-133 Jobs and Training Inventory (Division of Vocational Rehabilitation)
11-134 Checklist to Determine Eligibility for Level 4 and/or Deafblind CRP Services (Division of Vocational Rehabilitation)
11-146 Supported Employment Referral (Economic Services Administration)
11-149 Division of Vocational Rehabilitation (DVR) Customer Job Seeker Accommodation Worksheet
11-152 Forensic Navigator to Inpatient - Referral Information Form (RIF) (Office of Forensic Mental Health Services)
11-153 Governor's Opportunity for Supportive Housing (GOSH) Referral (Home and Community Services)
11-154 Personal Pathway
11-163 Applicant Certification and Assurances (Division of Vocational Rehabilitation)