KASVI Referral Form

KASVI Referral Form

    Participant Information - ** indicates required fields













    Guardian Information



    Employment/Vocational Information - ** indicates required fields






    Referral Information - ** indicates required fields






    Services Requested - Check all that apply

    Career planning is a service that provides support to the participant to identify a career direction; develop a plan for post-secondary education and/or plan for achieving job placement in competitive, integrated employment at or above the minimum wage.

    Job Finding is a service that provides assistance to the participant in developing job skills and securing competitive, integrated employment that fits the participant's needs and preferences as well as the employer's needs. Job support consists of assistance with learning job tasks, periodic follow-up and ongoing support with individuals and their employers.

    Supported Employment is a service that provides assistance to the participant at their job site for the maintenance of competitive employment. Supported Employment consists of increasing training and supervision needed to maintain and sustain employment.

    Home and community-based services are provided to individuals who need assistance in the acquisition, retention, or improvement of skills related to living and working in the community.

    Review of Eligibility Requirements
    • Must be 12–35 years of age at time of enrollment
    • Be an individual identified as having Autism
      • Special Education identification and documentation as a student with Autism and/or medical diagnosis of Autism Spectrum Disorder
    • Must reside in Lehigh County during application and while receiving services
    • Must be willing to provide follow up data after 6 months of exiting the program
    • Capacity to perform activities of daily living (i.e. bathing, eating, using the toilet)
    • Not exhibit levels of extremely problematic behaviors that present a danger to self, others or threat to property or require direct supervision to ensure health and safety
    In order to receive the maximum benefit of services, the following criteria must be met:
    • Flexible schedule to accommodate up to six hours of services a week
    • Active parental/family engagement
    • Collaboration with IEP team when applicable
    • Minimum four month commitment of individual and parent
    • Current/future goals to obtain/maintain competitive employment and/or post-secondary education
    • Not currently enrolled in a program which would result in a duplication of services


    If no, please specify in the space provided below. Information provided will be taken into account when determining enrollment.

    Please review the above information prior to submitting.
    If correct, submit the information using the button below.