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Senior Transit for Area Residents (STAR) Application

  1. STAR Program Application
    Please complete the information requested on the STAR application and a Human Services staff member will follow up with you for a telephonic interview. You will be asked to provide proof of age, current proof of residency, and proof of ADA Paratransit Certification (if applicable) to Skokie Human Services. You may upload these documents to your application at the very bottom. Human Services will assist you if you are unable to do this.
  2. Skokie Seal
  3. First, Middle Initial, Last
  4. Example: 01/01/1995
  5. Emergency Contact Information:
  6. Name, Relationship
  7. Please include area code
  8. Please include area code
  9. Please include area code
  10. Please include area code
  11. To meet Federal funding requirements answers to the following questions are needed. (Your answers will not affect your eligibility for the STAR Program.
  12. Sex:
  13. What is your race?
  14. Are you Hispanic?
  15. Gross household income is:
  16. Electronic Signature Agreement*
    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
  17. For a telephonic interview, please call 847-933-8208
  18. Leave This Blank:

  19. This field is not part of the form submission.