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Vocational Rehabilitation

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Participant Services Policy and Procedures Manual

NV State Rehabilitation Council

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Rehabilitation Division
Forms and Documents


Applications for Vocational Rehabilitation
Nevada State Rehabilitation Council Annual Report
State Plan
Nevada State Needs Assessment Powerpoint Presentation
Client Satisfaction Surveys
Job Developer Forms


Form or Document Name Format(s)
Applications for Vocational Rehabilitation:
Vocational Rehabilitation Services Application*
Excel PDF
Vocational Rehabilitation Services Application Large Print*
Excel PDF
Vocational Rehabilitation Services Application in Spanish*
(Solicitud de servicio de rehabilitacion profesional)
Excel PDF
*Note: Applications can only be accepted in person.  (Vocational Rehabilitation Locations)
If you require any assistance in completing the application, a counselor or technician can assist you.
Older Individuals Who Are Blind
Program Application
Nevada State Rehabilitation Council Annual Report:
Annual Report 2017
Word PDF
Annual Report 2016
Annual Report 2015
Annual Report 2014
Annual Report 2013
State Plan:
FFY 2015 State Plan
Word PDF
FFY 2014 State Plan
FFY 2013 State Plan
Word PDF
Nevada State Needs Assessment:
Nevada Comprehensive Statewide Needs Assessment (CSNA) Report
Client Satisfaction Surveys:
FFY 2016 Satisfaction Survey Report
FFY 2015 Satisfaction Survey Report
REQUIRED Job Developer Forms:
CBA Agreement   PDF
Job Club Report   PDF
Job Placement Plan Checklist and Template   PDF
Job Seeker Activity Report   PDF
Job Seeking Skills Class Report   PDF
PETS Attendance Sheet   PDF
PETS Student Tracking Summary   PDF
PETS Training Evaluation   PDF
PETS Training Report   PDF
PETS Training Weekly Report   PDF
Verification of Employment   PDF
Verification of Successful 30-60-90 Days
Word PDF
SAMPLE Job Developer Forms:
CBA Accept / Reject Report   PDF
CBA Final Exit Summary Report   PDF
CBA Job Duties   PDF
CBA Provider Checklist - Job Coaching and Monitoring Reports   PDF
CBA Supervisor Weekly Report   PDF
Job Coaching Task Analysis Report   PDF
Job Development Phase I Report   PDF
Job Development Phase II Report   PDF
Supported Employment Report   PDF
Task Analysis   PDF


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(702) 486-5230

(702) 486-1018
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(775) 684-8400

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Nevada Department of Employment, Training & Rehabilitation
2800 E. St. Louis Ave. Las Vegas, NV 89104
500 East Third Street  -  Carson City, NV 89713
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TTY (800) 326-6868 or Nevada Relay 711

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