EI Home Pack Request Form

Complete this form to receive your free EI Home Pack and sign up for the Early Intervention Clearinghouse newsletter. Available to Illinois residents only.

Complete este formulario para recibir gratuitemente el "EI Home Pack" (páginas de consejos para el hogar) y para suscribirse al boletín del Centro E.I.
Disponible solamente para residentes de Illinois.

Full Name/Nombre completo

Complete this form to receive your free EI Home Pack and sign up for the Early Intervention Clearinghouse newsletter. Available to Illinois residents only.

Email answer must be an email address

EI Home Pack Request Form

EI Home Pack Request Form

Full Name/Nombre completo

Email answer must be an email address

Phone/Teléfono answer must be phone number with area code like 217-333-1000

Mailing Address/Dirección

City/Ciudad

Zip Code/Código postal answer must be a zipcode like 61864 or 61864-8180

Illinois county you live in/Condado de Illinois donde vive

Of the following, which best describes you? De la siguiente lista, ¿cuál opción lo/la describe mejor?