Follow the steps to complete your certification accurately

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter the name of the Firearm Owner’s Identification (FOID) card petitioner in the designated field. Ensure the full name is entered, including the last name, first name, and middle initial.
3. Input the date of birth of the petitioner in the format provided (MM/DD/YYYY). This information should be accurate to avoid delays in processing.
4. The evaluator, who is either a physician, clinical psychologist, or qualified examiner, must affirm their qualifications by checking the appropriate boxes and providing the necessary verification data.
5. The evaluator should mark the relevant boxes indicating the assessment of the petitioner, based on their evaluation regarding threats of violence or self-harm.
6. In the 'Explanation/Comments' section, the evaluator must provide any pertinent details supporting their assessment and findings.
7. The evaluator must print their name, sign the form, and include the date of signing, along with their professional license number, state of issuance, National Provider Identifier (NPI) number, printed address, phone number, and fax number.
8. After completing all sections of the form, the evaluator should save changes, download, and print the form as necessary. The original document must be returned directly to the Illinois State Police.

Complete your documents online with confidence and ensure accurate filing.