Online Forms Cabinet

Virginia Department for the Blind and Vision Impaired Forms
Services that may be provided include, but are not limited to, training to assist individuals in adjusting to the loss of vision; vocational and adjustment counseling and training, eye surgery and/or eye treatment for a limited number of individuals; adaptive equipment for training and/or employment; rehabilitation engineering services to modify training and/or job sites; and supported employment services for individuals who are blind and have other disabilities. Job placement and follow-up services are also provided and are given major emphasis.

Form	Word	PDF	Excel
Appeals
Service Complaint - Grievance Form
Applications
Application for Services
Application for Vocational Rehabilitation Services
Application for Volunteer Services
Authorizations
Access to Client Information
Cafeteria Menu
ABL MANAGEMENT INC MENU 401.2 WEEK 2
ABL MANAGEMENT INC MENU 401.2 WEEK 3
ABL MANAGEMENT INC MENU 401.2 WEEK 4
Equipment
Equipment Agreement Receipt Form
Financial Information
Financial Determination-Redetermination Statement Form
Medical
Eye Exam Report
Health Checklist - General Medical Examination
Program Services
Orientation and Mobility Permission Form
Orientation and Mobility Permission Form Instructions
Releases
Child-Parent Rights and Responsibilities Form
Consent to Release Information
Super Summer Camp
Library and Resource Center Forms Library services are offered to persons who are physically disabled, visually disabled, hearing impaired or reading disabled.
Applications
LRC Application for Service
Equipment
LRC Adaptive Equipment Order Form
LRC Adaptive Equipment Return and Repair Replacement Form
LRC Book Retention and Adaptive Equipment Re-Assignment Form
Order Forms
LRC Book Order Form
Textbooks
Textbook Order Form
Textbook Retention and Re-Assignment Form
Textbook Return and Confirmation Form