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Certification Packet

The certification packet consists of the following documents. NOTE: Each applicant must submit BOTH a Legal Entity Application and the appropriate Service Specific Application.

  1. Legal Entity Application
    Complete only one application per Adult Day Service, Automated Medication Dispenser, Emergency Home Response, and/or In-Home Service legal entity.

  2. Service Specific Applications

All forms must be completed accurately before processing can be started. Any incomplete packet will be returned. Be sure to maintain a copy for your records.

Return your completed certification packet to:

Illinois Department on Aging
Attn: Office of Service Development and Procurement
One Natural Resources Way, Suite 100
Springfield, IL 62702-1271


We appreciate your interest in becoming a service provider under the Community Care Program!