Contact Name* Email* Enter Email Confirm Email Phone*Day Care Home Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code DCFS License # Reason contacting ICCB Request for an introductory visit Direct deposit form and information Provider advising they will be closed (please note specific dates below in message area) Provider advising they will be out on a field trip (please note specific date, departure time, location and return time below in message area) Provider requesting help with Minute Menu Provider requesting supplies (forms and envelopes – specify items below in message area) Provider sending files Other (specify below in message area) MessageUpload File(s) Drop files here or Select files Max. file size: 256 MB. CAPTCHAEmailThis field is for validation purposes and should be left unchanged. Δ
