Tribal Vocational Rehabilitation (TVR) Application

LEKT Vocational Rehabilitation Program is a voluntary program that serves eligible enrolled tribal members who are seeking employment and reside within LEKT service area. Eligibility for TVR services requires a diagnosed physical, mental, emotional or learning disability that is documented by a professional and is shown to be a barrier to employment. TVR services will be provided to eligible tribal members to assist them to regain, retain or to prepare for and secure employment particular to their strengths, abilities, capabilities, experience, priorities and resources through informed choice.

Eligibility Criteria:

Must be enrolled in a State or Federally-recognized Indian Tribe or Alaska Native Village;
Have documented physical or mental disability which results in a substantial impediment to employment;
Reside in the LEKT service area from the Hoko River and Sappho to the west, the Straits of Juan de Fuca to the north, and McDonald Creek to the east;
Require vocational rehabilitation services to obtain, maintain and retain appropriate employment

Name(Required)

First Middle Last Suffix

Date of Birth(Required)

MM/DD/YYYY

Gender

Male

Female

LGBTQ

Tribe of Enrollment(Required)

Enrollment Number

Street Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Mailing Address

Street Address City State / Province / Region ZIP / Postal Code Country

Do you have a disability?(Required)

Yes

What is your disability?

Phone Number(Required)

Alternate Phone

How did you hear about us?(Required)

What is your Vocational goal?(Required)

Are you working? If so where are you working? how many hours per week? How much per hour are you making?(Required)

Emergency Contact Name

First Last Suffix

Relationship

Emergency Contact Phone Number

Signature(Required)

Date