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
11-164 Community Rehabilitation Program (CRP) Services and Qualifications (Division of Vocational Rehabilitation)
11-164A Pre-ETS Service Identification (Pre-Employment Transition Services (Pre-ETS) Division of Vocational Rehabilitation)
11-165 Independent Living (IL) Services and Qualifications (Division of Vocational Rehabilitation)
11-167 Internship: Employer Evaluation
11-168 Internship: Customer Evaluation
11-180 Discovery Profile Report (Division of Vocational Rehabilitation)
11-181 Service Delivery Outcome Plan (SDOP): Customized Job Placement (Division of Vocational Rehabilitation)
11-182 Service Delivery Outcome Plan (SDOP): WRT- Experience D (Division of Vocational Rehabilitation)
11-182 Service Delivery Outcome Plan (SDOP): Customized Employment - Discovery (Division of Vocational Rehabilitation)
11-192 Request to Provide CRP-IL Services and Background Check: Create Account (Division of Vocational Rehabilitation)