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.
| Number(desc) | Form Name | File Format | |
|---|---|---|---|
| 10-700 | CCRSS Follow-Up Visit (Certified Community Residential Services and Supports, Residential Care Services.) | ||
| 10-707 | Residential Habilitation for Dependent Youth (RHDY) Engagement Plan (Developmental Disabilities Administration) | ||
| 10-708 | Planning for Youth Aged 18-21 Receiving RHDY Services (Developmental Disabilities Administration) | ||
| 10-709 | Request for Residential Habilitation for Dependent Youth Services (Developmental Disabilities Administration) | ||
| 11-022 | Application for Vocational Rehabilitation Services |
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| 11-030 | Service Delivery Outcome Report (Community Rehabilitation Program - CRP) | ||
| 11-058 | Trial Work Experience (TWE) Agreement (Division of Vocational Rehabilitation) | ||
| 11-066 | Assistive Communication Technology Request (Office of Deaf and Hard of Hearing) | ||
| 11-067 | Monthly Budget Worksheet (Division of Vocational Rehabilitation) | ||
| 11-068 | Customer Internship Program Internship Application (Division of Vocational Rehabilitation) |
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| 11-069 | DVR Internship Agreement (Division of Vocational Rehabilitation) |
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| 11-070 | DVR Attendance Log and Billing Invoice (Division of Vocational Rehabilitation) | ||
| 11-071 | DVR Employer Expense Worksheet (Division of Vocational Rehabilitation) | ||
| 11-084 | Contracted Employee(s) to Provide IL Services and Service(s) Approved (Division of Vocational Rehabilitation) | ||
| 11-088 | DVR, DSB, and PIHE Student Accommodation Cost Share Worksheet | ||
| 11-097 | Service Delivery Outcome Report (Independent Living Services - IL) | ||
| 11-098 | Vocational Assessment Worksheet |
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| 11-106 | Pre-ETS (Pre-Employment Transition Services) Self-Advocacy Training (Division of Vocational Rehabilitation) | ||
| 11-110 | Pre-ETS (Pre-Employment Transition Services) Informational Interview (Division of Vocational Rehabilitation) | ||
| 11-112 | Pre-ETS (Pre-Employment Transition Services) Job Shadow (Division of Vocational Rehabilitation) | ||
| 11-114 | Pre-ETS Student Sign-In Roster (Division of Vocational Rehabilitation) | ||
| 11-118 | Individualized Plan for Employment (IPE) Worksheet (Division of Vocational Rehabilitation) | ||
| 11-119 | Informational Interview Worksheet (Division of Vocational Rehabilitation) | ||
| 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) |
