Texas Workforce Commission
Vocational Rehabilitation Services
Vocational Adjustment Training (VAT)
Work Readiness Training Referral
General Instructions
Follow the instructions below when completing this form.
 Refer to the DRS Standards for Providers for additional details;
 Complete the form electronically (on the computer) and answer all questions; and
 Before faxing, emailing encrypted, or mailing to the provider, review this form to ensure that all
questions have been answered.
Note: The DARS staff collects the information and completes all sections of this form.
Date of the referral:
Referral for:
Exploring the “You” in Work
Soft Skills for Work Success
Soft Skills to Pay the Bills—Mastering Soft Skills for Workplace Success
Entering the World of Work
Preparing for the Job Search—For Students with Disabilities Only
Disability Disclosure Training
Money Smart—A Financial Training
Public Transportation Training
A. Consumer Identification Information
Consumer’s name:
Street address (include apartment number, if any):
City:
State:
Primary contact number:
(
)
Secondary contact number:
(
)
ZIP code:
Email address:
DARS case ID:
Date of birth:
Consumer’s disability:
B. Alternate Contact Person Identification Information
Alternate contact’s name:
DARS3121 VAT (05/15) A+
Work Readiness—Referral
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Alternate contact’s primary contact number:
(
)
Alternate contact’s secondary contact number:
(
)
C. Additional Information Provided by DARS at Referral
Enter X to select all that apply.
IPE copy
Vocational testing
Medical and/or psychological reports
Work history collected by DARS
Case notes (for example, eligibility,
assessment and planning)
Work references collected by DARS
Other:
Other:
D. Counselor Contact Information
Counselor’s name:
Counselor’s primary DARS office:
Counselor’s DARS office street address (include suite number, if any):
City:
State:
ZIP code:
Counselor’s primary contact number:
(
)
Counselor’s secondary contact number:
(
)
Email address:
E. Provider Chosen by the Consumer
Provider’s name:
Email address:
Provider’s phone number:
(
)
Provider’s fax number:
(
)
F. Additional Comments
Additional comments:
DARS3121 (05/15)
VAT for Work Readiness—Referral
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