DVR Interest & Referral Form

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We are excited you are interested in learning more about DVR. We work with people who have a documented disability to empower them to reach their employment goals through providing a variety of services. Please fill out the form below so that we can connect you with the office closest to you! A DVR staff person will respond to you within 2 business days. Please do watch our Orientation Video to see if our services are what you are looking for! Do know that if you are interested in our services, the next step is an application and an initial engagement meeting.

If you need immediate assistance, please contact us at CDLE_voc.rehab@state.co.us.

Email *

Orientation to DVR Video: Please watch first to see if we are the right program for you!

Or, if you are a youth aged 15-24, watch our Getting Started with CO DVR Youth Services video:

Name (first and last - and if you have a preferred name, please let us know) *

Best phone number to reach you *

How would you prefer to be contacted: *

Text

Phone

Other:

Your address: street, city, zip code *

If you know which DVR location would best work for you, please indicate below:

Are you: (Answering this will help us connect you with the right counselor. Many of our counselors specialize in working with youth, or with specific disabilities. Please check all that apply.) *

Currently attending high school

Currently attending a post-secondary program

Aged 15 - 24

Adult over the age of 25 looking for employment

Blind or low vision

Deaf

Hard of hearing (for example, need assistance in obtaining hearing aids to fully engage in work)

Experiencing mental health or behavioral health challenges (could include PTSD, depression, schizophrenia, anxiety)

Neurodiverse or on the autism spectrum

Working with a local community centered board (CCB)

Physical mobility barriers

Spinal cord injury

Brain Injury

Experiencing homelessness

Other:

Required

How did you learn about DVR? *

Center for Independent Living

Colorado Office of Employment First (COEF)

Community Centered Board (CCB)

Community Mental Health Center

Employer

Family member

Friend

High School

Post Secondary Program

School to Work Alliance Program

Workforce Center

Ticket to Work

Other:

Required

How can DVR help you with employment? *

Short or long term training (may include on-the-job training, certificate program, or further post-secondary training)

Job development (may include 1:1 assistance in finding a job, either from internal or external providers)

Job coaching (individualized supports while on the job, may be on or off site)

Orientation and Mobility Training (assistance with learning new environments for those who are Blind)

Mental restoration services (may include working with a psychologist, therapist, or other services to support behavioral health needs)

Physical restoration services (could include physical therapy)

Assistive technoloy (may include accommodations, may be technology such as screen readers)

Self-Employment services (assistance in starting a new business)

Assistance in applying for disability benefits such as SSI or SSDI

Other:

Required

Please tell us your comfort level with various technology, including computer skills and virtual meetings. *

No experience

Highly experienced and comfortable

If you are completing this form on behalf of another individual, please tell us the best way to reach you if needed:

Do you have any questions for us?

Please tell us the best time of day to reach you. *

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