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Ate of Birth: Social Security Number: Disability: What assistance is required to become employed? How did you hear about DVR? Other: Please mail or fax the completed form to the office location nearest you. Division of Vocational Rehabilitation 4425 North Market Street Wilmington, DE 19802 Tel: 302-761-8275 Fax: 302-761-6633 Attn: Wilmington Office Division of Vocational Rehabilitation Pencader Corporate Center 225 Corporate Blvd, Suite 204 Newark, DE 19702 Tel: 302-368-6980 Fax: 302-368-698.

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