Forms

Referral

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Referral Form (64.9kb)

This form has three parts, labeled A, B, and C respectively.

Part A: Certification of Eligibility By completing this section, a VR counselor certifies that the client is eligible for extended employment services. Only a VR Counselor may certify a client and the counselor’s signature on the form is required to make certification official. The counselor also records the client’s first and second choice of CRP provider in Part A.

Part B: Waiting List The VR counselor indicates the service type necessary--either status 51, status 52, or status 60.

Part C: Decertification Whenever a client passes away, moves out of the area, refuses EE services, or no longer needs such services, a VR counselor or CRP representative marks the decertification line corresponding to the client’s status and records the reason for client’s decertification from the program.

A copy of a completed Referral form must be sent to RMR so that the information may be inputted in the EE database.