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CPR Voucher Eligibility Form
Please fill out this form to determine participation eligibility in our free comprehensive CPR program. One of our dedicated support staff members will reach out to you after your information has been processed. Please email
cpr@kendelshermanfoundation.org
if you have any questions.
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* Indique une question obligatoire
Your Name
*
Votre réponse
Phone Number
*
Votre réponse
Email
*
Votre réponse
Are you aged 13 or older?
*
Yes
No
Are you a resident of Boone or Winnebago County?
*
Yes
No
Do you currently receive support through the Illinois Department of Human Services (e.g., SNAP, Medical card, LIHEAP, PIPP)? You will be required to submit verification of current support if approved.
*
Yes
No
In-person classes will be offered on weekends (Saturday & Sunday) at various locations across Winnebago County. Are you available to attend either of those days? Exceptions will be made when more than 5 participants need an alternative day.
*
Yes
No
Autre :
We offer a Blended CPR course (partially online). Do you currently have access to a computer or mobile device to complete the online course? If not, we will provide alternatives at your in-person intake meeting.
*
Yes
No
Maybe
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