Professional Licensure Assistance Request

Licensure Assistance Request

"*" indicates required fields

Are you seeking assistance with an application you have already submitted to IDFPR?*

Contact Info

Your Name*

First Last

Your Home Address*

Street Address City State ZIP Code

Your Email Address*

Email Address Confirm Email Address

Your Phone*

Please provide the following information:

Applicant name (as it appears on the application)*

Date of birth*

Last 4 digits of Social Security Number (SSN)*

Date application submitted*

How was application submitted?*

How was application mailed to State of Illinois?*

Shipper Name*

Do you have a mail/shipper tracking number?*

Mail/shipper tracking number*

Is application for a business or personal license?*

Provide FEIN*

Profession Type

Profession Code #

Type of application submitted*

Do you have a current license?*

What is your license #?*

Payment Method*

Provide your check or money order #

What was the amount of your payment to the state?

Please let us know if there is anything else we need to know to assist you with renewing your professional license or tracking down the status of your application?

How can we help? Please explain the situation in detail.*

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