Please print your form, complete it then send it to Care Connect by scanning the form and emailing it to This email address is being protected from spambots. You need JavaScript enabled to view it., fax to 618-687-4933 or mail to - Care Connect, P.O. Box 307, Murphysboro, IL 62966.

Travel Voucher

Emergency Assistance Request Form (Rent/Mortgage/Utility)

Illinois Ryan White Monthly Household Income Statement

Notice of Privacy Practices

IL Ryan White Authorization to Release Form

SIHCC Grievance Policy and Procedure Form

 

For additional information, please contact your case manager (618) 684-3143, ext. 155 or (877) 745-1424.