Interest Form for Rehabilitation Services

Vocational Rehabilitation Services (VRS) can help you prepare for, find and keep a job, and live as independently as possible. Our mission is to empower Minnesotans with disabilities to achieve their goals for employment, independent living and community integration. We do this by offering training, preparation and workplace accommodations.

VRS is an eligibility-based program. We currently have a waiting list--not everyone who applies will be served right away.

If you answer yes to the following questions, Vocational Rehabilitation Services (VRS) may be the place for you:
• Are you a person with a disability?
• Are you looking for a job or career in your community earning competitive wages?
• Are you ready to set job planning goals?

If you are a student in high school or in an age 18-22 transition program, please email vrs.studentclasses@state.mn.us to connect about services for students.

Fill out the form below so that we can connect you with the office closest to you!

An asterisk (*) indicates a required field.

Name

*First Name

*Last Name

Preferred Name

Pronoun

*Birth Date of person interested in services

Address

Are you homeless?

Address 1

Address 2

City

State

Zip Code

County

How would you prefer to be contacted (at least one is required)?

Phone

Phone Type

Text Message

E-mail

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

*Are you completing this form for someone else?

*Primary Language

*Do you need an interpreter?

Are you: (Answering this will help us connect you with the right counselor. Many of our counselors specialize in working with specific disabilities. Please check all that apply.)
Deaf or Hard of Hearing
Enrolled in High School
Receiving Services from Medicaid Waiver (ex. CAC, CADI, DD, BI)
Receiving Services through Individual Placement Support Services (IPS)
Other

Tennessen Warning

*Privacy Notice: This notice describes how private information about you may be used and disclosed. Please review it carefully. Vocational Rehabilitation Services (VRS) is asking that you complete the form above. VRS will use this information to let you know which vocational rehabilitation (VR) services may help you and to connect you with the appropriate VRS staff for further follow-up. You don’t have to give us information about yourself, but without the information we may not be able to tell you what VR services could help you or connect you with the right VRS staff person.
The personal information you provide on this form is private and will only be shared with staff who have a need to know the information or as required by law.

By completing and submitting this form you confirm the following:
1. You have read and understood the information provided above and you agree to supply the information requested to complete this form.

2. You understand that your information may be used as described above.

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