Get Caregiver Application Form - State Of Illinois - Www2 Illinois

This guide provides detailed instructions for completing the Caregiver Application Form required for the Illinois Medical Cannabis Pilot Program. By following the steps outlined below, users will ensure that their application is filled out correctly and can be submitted online with confidence.

Follow the steps to successfully complete your caregiver application form.

1. Click the ‘Get Form’ button to access the application form and open it in the editor.
2. Select whether you are applying for a new registry identification card or renewing an existing card by checking the appropriate box.
3. Fill in the caregiver information section, including details such as first name, last name, social security number, driver’s license information, home address, and contact details.
4. In the qualifying patient information section, provide the required details about the patient you will be serving, including their name, contact information, and date of birth.
5. Attach proof of residency by including two supporting documents from the specified list, such as a utility bill or bank statement.
6. Include proof of identity and age by attaching a clear photocopy of a government-issued photo ID.
7. Supply a recent photograph of the qualifying patient following the stated requirements.
8. Complete the fingerprint consent form and arrange for fingerprinting as instructed, ensuring to submit the signed consent form with your application.
9. Include the application fee of $25, which can be paid via check, money order, or credit card for online submissions.
10. Review all entries for accuracy, sign and date the application, then submit electronically or print for mailing, ensuring all documents are included.

Complete your caregiver application document online today to ensure timely processing.