Wufoo
E1MN Request Form
Please use this form to submit questions, requests, feedback or to get review of local resource related to E1MN that you would like addressed. If your inquiry concerns a specific person or case, please do not include personably identifiable information to preserve privacy. If this information is needed, it can be gathered during follow up to your inquiry.
Name
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First
Last
Email
*
Phone Number
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###
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Your role
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VRS/SSB staff
Lead agency staff/waiver case manager
School staff
Employment service provider
Other
Maximum of
250
characters.
Currently Used:
0
characters.
What does your inquiry concern?
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E1MN processes, procedures or collaboration across VRS/SSB, waiver, or school services (Routes to E1MN interagency inbox)
Vocational Rehabilitation Services or State Services for the Blind (VRS/SSB) (Routes to VRS/SSB inbox)
Home and Community Based (HCBS) waiver services (Routes to DSD Response Center)
School or transition services (Routes to MDE special education inbox)
What best describes your inquiry?
*
Question for which you would like a direct response
Feedback for the E1MN team (e.g., suggested improvements, areas of confusion, need for local area information, etc.)
Share a success story like an example of great local partnership, or a person's employment success
Locate trainings, resources, or tools on a topic
Request review of information, training or tool developed by local team (attach resource below)
What is the question, request, or feedback that you would like addressed?
*
Attachment: If you have a document or file associated with your request, please attach it here.
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