GOVERNMENT OF THE DISTRICT OF COLUMBIA
DEPARTMENT OF HUMAN SERVICES
REHABILITATION SERVICES ADMINISTRATION
CLIENT SERVICES DIVISION
810 First Street N.E., 9th Floor
Washington, DC 20002-2247
Telephone: (202) 442-8400
CERTIFICATION OF ELIGIBILITY
3801 CONN. AVE., NW
Washington DC 20008
A preliminary assessment has been completed that included:
1) information that you, your family, other authorized representatives and advocates provided; and
2) information from existing records and other information.
Based on this assessment it has been determined that you have been found eligible for vocational rehabilitation services.
A. You have a physical or mental impairment
2) you can benefit in terms of an employment outcome and
B. You require vocational rehabilitation services to secure, prepare for, regain or retain a successful employment outcome.
Client Signature: /s/ Gary Freedman
Date of Client Signature: 3-7-06
Representative/Guardian Signature (when necessary):
Counselor Signature: Eugene Weatherford
Copy provided to client on (date):