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Forms and Documents

  
 

IMOS Forms

- Age and Length of Membership

- Instructions for Completing Application for Assistance

- Application for Assistance

- Compliance Agreement

- Waiver

- Widow Assistance

State of Illinois

- Online application for Extra Help Program

- Illinois Cares Rx Online Application IL-1363 Online Form

- BenefitsCheckUp Online

For assistance completing any of the forms above contact:

 Karla K. Carwile, MA, MA, LCPC, DCC
Director of Outreach Services
Grand Lodge of Illinois
2866 Via Verde    
Springfield, Illinois 62703 
Phone: 217-529-8900- ext 12    
Fax: 217-529-0242