Hodgkins, IL · Cook County
Freedom Alert Device Application
Hodgkins residents can use this application to request consideration for the village’s Freedom Alert pilot program.
What this form is
This application is for people seeking consideration for the Freedom Alert pilot program. It asks for the applicant’s name, address, phone number, and date of application, plus information about eligibility or other conditions for consideration. The applicant certifies that the information is true and accurate, then signs and dates the form.
Who needs it
Residents who meet the listed age and caregiving criteria, or who want consideration based on other conditions, can submit this application.
How to submit it
Submit it to the city department named on the form; check the city website for current contact details.
About notarization
This application is signed and dated without a notary; the signer certifies the information is true and accurate, and no notarized attachment is identified.
How to submit this form
- 1
Download The Application
Download the Freedom Alert Device Application PDF.
- 2
Complete The Application
Enter your application date, name, address, and phone number, then check the applicable eligibility option or describe other conditions.
- 3
Review And Sign
Certify that the information is true and accurate, then sign and date the application. No attachments are listed.
- 4
Submit To The City
Submit the completed application to the city department named on the form; check the city website for current contact details.
Frequently asked questions
- Who can apply for the Freedom Alert device?
- The form lists people age 65 or older who live alone and people age 60 or older who are primary caregivers for an incapacitated household member. It also allows others to request consideration.
- What information does the application request?
- It asks for the applicant’s name, address, phone number, and application date, along with applicable eligibility information or other conditions for consideration.
- Do I need a notary for the Freedom Alert Device Application?
- No. The applicant signs and dates the form and certifies the information is accurate; it identifies no notarized attachment.
- How do I submit the Freedom Alert Device Application?
- Submit it to the city department named on the form; check the city website for current contact details.
Need something notarized?
This Freedom Alert Device Application doesn’t need a notary — but Illinois residents can notarize other documents online with a commissioned online notary.