CPR Voucher Eligibility Form

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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.

Your Name *

Phone Number *

Email *

Are you aged 11 or older? *

Yes

Are you a resident of Boone or Winnebago County? *

Yes

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

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

Other:

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

Maybe

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