DHS: Rehabilitation Services: Apply Online

If you live in Illinois and have a disability, the Division of Rehabilitation Services may be able to help you find a job or live at home independently.

To apply for services, begin by completing the form below. Once you have submitted this form, a counselor will contact you to set up an appointment to complete the application process. During this appointment, we will discuss your goals, the nature of your disability, and the services we can provide.

To learn more about the types of services available, please see Rehabilitation Services.

Service

I would like help getting or keeping a job

I would like help living independently at home

I have the most difficulty

First Name

Middle Name

Last Name

Generation

Gender at Birth

Date of Birth

Social Security Number

Zip Code

Street Address

Apartment Number

City

County

Phone Number

Phone Mode

Phone Type

Email Address

Verify Email Address

Language Preference

Other Language

Are you transitioning from a long term care facility?

Referral Source

Managed Care ID

Decree Provider ID

Medicaid RIN

Primary Impairment

Primary Cause

Referral Source Name

Decree Type

Have you completed an Assessment?

Referral Source Phone

Referral Source TTY

Referral Source Email

Verify Referral Source Email

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