November 6, 2001
MEMORANDUM FOR DISTRICT SUPERVISORS, REHABILITATION COUNSELORS AND RSB EXECUTIVE STAFF
FROM: Sally Howard, Deputy Director
SUBJECT: Revised PVA at a Glance Selection Form
Effective immediately begin using the attached revised PVA at a Glance Selection Form. The form is now a two-sided document. Please complete all of the sections on the back side of the form. Please consistently go over the information on the PVA at a Glance Selection Form with your consumers and encourage them to seek out additional information as well.
Thanks for your time and cooperation. SH:mlg
Attachment
cc: Clerk IV’s
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Consumer Name: |
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(Print) |
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Students with residual vision are required to wear their sleepshades from 8:00 a.m. to 4:30 p.m. at the facility, unless it is mutually agreed upon between the student and staff member for a break or a specific activity.
I have reviewed all of the information regarding my contractual choices for rehabilitation facility training.
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My informed choice is |
Yes |
No |
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I have read their Student Handbook and agree to their rules. |
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Consumer Signature: |
Date: |
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Counselor Signature: |
Date: |
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