Serving the following counties in Illinois:
Boone, Carroll, DeKalb, Jo Daviess, Kane, Lee, McHenry, Ogle, Stephenson, Whiteside and Winnebago.

Request for Emergency Assistance

Please only send one request for assistance. Multiple requests will significantly delay a call back response.
There is often a waiting list for case workers to call back regarding applications. We appreciate your patience in this matter.
* = Required Field

Request Details *

Limit: 0 / 450

First Name *

Middle Initial

Last Name *

Sex *

Significant Other's First Name

Middle Initial

Last Name

Address *

City *

State *

Zip code *

County *

Phone #1 *

Phone #2

Email Address

Date of Birth *

Significant Other's Date of Birth

Household *

Head of Household
Significant Other
Child #1   
Child #2   
Child #3   
Other #1  

Marital Status *

Single
Married
Separated
Divorced
Widowed

Language *

English
Spanish
ASL
Other   

Custody of Children

Yes
No