Mask Request - Chicagoland and Western Suburbs
Please use this form to request a mask for yourself. Providing what is asked for on the form will allow us to quickly process your request. A mask maker will contact you to arrange porch pick-up. Please note the following:
- Please provide proof of your credentials and place of employment to
- Requests for 10+ masks require documentation so we can confirm the need.
- These masks are 100% cotton, lined with a non-woven material, they are not as effective as N95 masks.
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First and Last
City of residence
Are you a health care worker, first responder, school or daycare employee?
What are your credentials and current place of employment (e.g., Custodian at CPS)
You MUST include your credentials and place of work. All requests will be verified. To expedite the process, please send proof of your credentials and place of employment to
How Many Masks are you requesting
If you are requesting for additional people. Requests for multiple masks require documentation so we can confirm the need. We will do our best to support you.
Do you prefer Adult - Elastic; Adult - Ties, or Child masks? (we will try to meet this request if possible)
Adult - Elastic
Adult - Ties
Adult - it doesn't matter what kind
Other (describe below)
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