Virginia - Clusiv

Clusiv is proud to Serve Virginia DBS

Course Enrollment

Enroll a client in Clusiv training.

Counselor Name(Required)

First Last

Counselor Email(Required)

Counselor State or Organization(Required)

Client Information

Client Name(Required)

First Last

Client Email(Required)

Client Phone(Required)

Client Gender(Required)

Disability Type

Client Birth Date

Screen Reader Experience Level(Required)

What Course are they enrolling in first?(Required)

Upload Authorization

Max. file size: 2 GB.

Assessment Enrollment

Enroll a client in Clusiv Assessment.

Counselor Name(Required)

First Last

Counselor Email(Required)

Counselor State or Organization(Required)

Client Information

Client Name(Required)

First Last

Client Email(Required)

Client Phone(Required)

Client Gender(Required)

Disability Type

Client Birth Date

Please Select the types of training your client has previously completed(Required)

Center based AT Training

1:1 AT Training

O&M / VRT

Occupational Training

Which Assessment does your client need?(Required)

Upload Authorization

Max. file size: 2 GB.

Clusiv is proud to Serve Virginia DBS

Course Enrollment

Client Information

Assessment Enrollment

Client Information

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