Premise Alert Program Notification Form

The Illinois Premise Alert Program provides for public safety agencies in the State of Illinois to allow people with special needs to provide information to Police, Fire, and EMS personnel to be kept in a database. The information can then be provided to the emergency units responding to the specified locations in dealing with the situations involved in the special needs individuals.

Citizens electing to participate in PAP must be advised that the provision of special needs information will not result in preferential treatment. The establishment and continued existence of PAP shall be based on funding availability. The information provided by you will be kept confidential and used only to provide emergency personnel the information needed to deal with situations or emergencies dealing with special needs persons. For any questions about this program, please contact the Technical Services Supervisor via email or at 847-359-9096.

Program Form

The Premise Alert Program form (PDF) must be completed and signed and can either be mailed to the address on the form, or faxed to 847-963-6215. Although photographs of the special needs individual are not required, you may provide one by mail with your completed form.