Care Card Voucher Request Form
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Email *
Conference/Agency *
Address of Conference/Agency *
Thrift Store Location *
Conference/Agency Member Submitting *
Conference/Agency Member Phone # *
Conference/Agency Member Email *
The Care Card Voucher Program is designed to help people get on their feet and provide assistance during difficult times.  Below you will find guidelines and suggestions for request amounts. There will also be limits set per household per year. 
Suggested Amts and Limits
Clothing- limit $300 (suggested $50 per person- $75 if business or winter coat is needed)
Shoes-  limit $100 ( suggested $25 per person)
Household- limit $100 (includes dishes, pots and pans, lamps, area rugs)
Furniture- limit $300 (sm. items- $50 per item   lg. items- $150 per item )
There will be a cap of $300 per care card and a cap of $500 for emergency situations (fire, flood, domestic violence)
Diapers and Feminine Hygiene Products- 10 packs per year ( 10 items per pack)
If you feel your case requires additional assistance please feel free to call Danielle with any questions or for further information.
For whole house furniture needs, please reference the Chicago Furniture Bank program and also contact Danielle at the information below  or 773-779-6700 ext 109  
First and Last Name of Client/Friend
Date of Birth
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Client Cell Phone #
State ID: ( ID or Driver's License)
Has Client had or requested a CCV before
Clear selection
Household Size
Clothing Needs Adult Male(Enter $ Amt)
Clothing Needs Adult Female(Enter $ Amt)
Clothing Needs Child One (Enter $ Amt)
Clothing Needs Child Two (Enter $ Amt)
Clothing Needs Child Three(Enter $ Amt)
Clothing Needs Child Four(Enter $ Amt)
Clothing Needs Additional (Enter $ Amt)
Shoes (Enter $ Amt)
Household Items(Enter $ Amt)
Furntiure Items (Enter $ Amt)
Linen Items(bedding, towels, etc)(Enter $ Amt)
Queen Mattress Needs (Adult Only)
Full Mattress Needs (1 per Household)
Twin Mattress Needs
Members Mark Infant\Toddler Diapers
How many packs of diapers? (10 per pack)
Clear selection
Adult Absorbent Underwear for Incontinence
How many packs of underwear?(10 per pack)
Clear selection
Feminine Hygiene Products
How many packs of feminine hygiene products? (10 per pack)
Clear selection
Please add any additional notes in this field
Thank you for submitting a Care Card Voucher request. Please allow a minimum of 5 business days for your care card to be processed and prepared. If your request includes mattresses, please allow a minimum of 14 business days for your care card to be processed and prepared. You will be notified as soon as your care card is available via email. If you have any questions, concerns or need additional assistance please feel free to contact Danielle at or (773) 779-6700 ext. 109
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