Vocational Rehabilitation
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Form 740 - 
Psychological Consultant's Review -  259 KB
Form 741 - 
Medical Consultant's Review -  349 KB
Form 742 - 
Visual Consultant's Review -  285 KB
Form 743 - 
General Health Checklist -  319 KB
Form 744 - 
Chemical Dependency Consultant's Review  -  258 KB
Form 745 - 
Referral to the Chickasaw Nation Vocational Rehabilitation Program  -  276 KB
Form 746 - 
Application for Vocational Rehabilitation Services (Consumer Rights and Remedies) -  249 KB
Form 747 - 
Consumer Initial Intake Information -  492 KB
Form 748 - 
Statement of No Income/Statement of Residency  -  239 KB
Form 749 - 
Documentation Checklist  -  270 KB
Form 750 - 
Consumer Responsibilities  -  242 KB
Form 751 - 
Release of Confidential Information  -  303 KB
Form 752 - 
Referral from the Chickasaw Nation Vocational Rehabilitation Program  -  253 KB
Form 753 - 
Statement of Appointment Attendance  -  241 KB
Form 754 - 
Training Progress Report  -  243 KB
Form 755 - 
Absences/Grade Policy for Consumers in Training  -  239 KB
Form 756 - 
Consumer Budget for Training  -  597 KB
Form 757 - 
Consumer Mileage Report  -  260 KB
Form 758 - 
On The Job Training Monthly Progress Report  -  271 KB
Form 759 - 
Consumer Service Log  -  252 KB
Form 760 - 
Job Search Log  -  255 KB
Form 761 - 
Business Plan Questionnaire  -  253 KB
Form 762 - 
03-04 Maximum Allowable Training Costs  -  38 KB
Form 763 - 
Needs Analysis  -  258 KB
Form 924 - 
Special Needs Assistance for Chickasaw Citizens with Disabilities -  108 KB
Brochure -  408 KB
(26) Forms

222 S. Mississippi
Ada, OK 74820
(580) 436-0553
TDD: (580) 310-9364
Fax: (580) 436-0830 


About

voc rehab group photo

voc rehab group photo

Mission:
To enhance the lives of American Indians with disabilities through successful employment outcomes.

Vision:
To be a model program that sets a standard of excellence for tribal vocational rehabilitation across the nation.

Please email our office with any questions or to request information.

Vocational Rehabilitation Consumer Satisfaction Survey
Fine Print

Vocational Rehabilitation Consumer Satisfaction Survey
Large Print

Eligibility

  1. You must be a member of a federally recognized tribe.
  2. You must have a documented physical or mental disability which results in a substantial impediment to employment.
  3. You must reside within the program's service area.

Chickasaw Nation Service Area Counties

Bryan Carter Coal
Garvin Grady Jefferson
Johnston Love Marshall
McClain Murray Pontotoc
Stephens

Application Process

  1. Contact the Chickasaw Nation Vocational Rehabilitation Program either by phone or in person.
  2. A vocational rehabilitation team member will take some basic referral information and either hand, mail, or fax you an application packet to complete.
  3. A vocational rehabilitation team member will contact you to schedule an appointment with a vocational rehabilitation counselor for an initial interview.

You Provide

  1. Proof of household income
  2. Proof of tribal citizenship
  3. Proof of Social Security Number
  4. Proof of age
  5. Proof of current residence
  6. Proof of disability
  7. Information about past jobs
  8. Information about jobs you are interested in
  9. Information about requirements of those jobs
  10. Information about past training
  11. Information about training options
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