Anyone, 6 months of age and older, is eligible to receive the COVID-19 vaccine. Find your nearest vaccination location at
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Please complete the order form below. UCIA forms will be mailed via the U.S. Postal Service to the mailing address provided below.
*Select Non-US for STATE if outside of the US.
Disclaimer: This form request is being sent to the Illinois State Police and any abuse could lead to action taken by the Illinois State Police