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FOR DVR STAFF ONLY VRC ASSIGNED DIVISION OF VOCATIONAL REHABILITATION (DVR) Vocational Information APPLICATION DATE Please complete as much of this form as you can. This information will assist the

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2014 Alaska DVR DSHS TDD WorkSource SSDI DWI VIII TANF Probations Empl VII assistive IEP OMB SSA BEP BIRTHDATE Rican VRC IP Guamanian SSI Childrens III DUI VIDEOPHONE Laotian TTY Samoan Ethnicity

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