Outdated or Unsupported Browser Detected
DWD's website uses the latest technology. This makes our site faster and easier to use across all devices. Unfortunatley, your browser is out of date and is not supported. An update is not required, but it is strongly recommended to improve your browsing experience. To update Internet Explorer to Microsoft Edge visit their website.
Document Number: DVR-17445-E
Description: This form should be used to refer an individual for vocational rehabilitation (VR) services.
Comments: Form is protected from modification and enabled for form fill (includes tabbed fields for form completion). The print (pdf) version is available for viewing and printing only.
Content Contact: DVR Forms
Document Attachments:
DVR-17445-E (English Electronic Version - Word/148 KB)
DVR-17445-E-H (Hmong Electronic Version - Word/46 KB)
DVR-17445-E-S (Spanish Electronic Version - Word/41 KB)
DVR-17445-E-V (Vietnamese Electronic Version - Word/46 KB)
DVR-17445 (English Print Version - pdf/149 KB)
DVR-17445-H (Hmong Print Version - pdf/136 KB)
DVR-17445-S (Spanish Print Version - pdf/132 KB)
DVR-17445-V (Vietnamese Print Version - pdf/149 KB)
Note: If you need this form in an alternate format, please send a message to the Content Contact listed above.
DWD Contact Information
201 E. Washington Ave
P.O. Box 7946
Madison, WI 53707
(608) 266-3131
Sign up for DWD news and updates
A proud partner of the 
network