Success Stories

For your success story to be eligible for publication, a waiver must be signed and mailed to DVR upon submission. Please review the conditions below before continuing.

Customer Information:

* Indicates a required field.

* First Name:

* Last Name:

* Address:

* City:

* State:

* Zip Code:

* Customer's Work Phone:

()

* Customer's Home Phone:

()

* Disability:

* Employer (Company):

Job Title (if applicable):

* Date Employed or Mentored:

* Employer Contact Person
or Mentor:

* Employer Contact Person
or Mentor Phone:

()

Include image(s) with my story: Yes No

Success Story image requirements:

Up to 2 Customer pictures can be uploaded below.
Picture width will be adjusted to 240 pixels.
A second uploaded picture is permitted if your Success Story is at least 2400 charcters long.
The image format is restricted to jpg.

Upload first
customer photograph:

Upload second
customer photograph:

DVR Counselor's Information:

* First Name:

* Last Name:

* Address:

* City:

* State:

* Counselor's Work Phone:

()

* DVR services provided & why this Customer is
unique/interesting:

This information will be used to endeavor to have the media produce a story about this individual. Original submissions may be edited by DVR prior to publication. Any questions? Contact the VR Communications Office at (850) 245-3399.