Thank you for considering the Illinois Center for Rehabilitation and Education – Roosevelt (ICRE-R) Transition Program. We have enclosed an ICRE-R Application and the following list of required documents which must be completed and submitted for ICRE-R admissions consideration.

Complete your portion of the first two documents and submit to medical provider(s), who shall return them along with the third item and other documents:


FORM: Release of Information Medical (IL488-1700), for each medical care provider


FORM: Free of Communicable Disease and Request of Documentation Letter.


FORM: Certificate of Child Health Examination (Immunization Record) (IL444-4737)



Complete your portion of the first document and submit to school, which shall return both plus other requested documents:

FORM: Release of Information Education (IL488-1700), for school district


Copy of current IEP or Section 504 Plan



Provide the following:

FORM: Completed ICRE-R Application


Copy of student’s current medical insurance or Medicaid card


Copy of student’s birth certificate


Copy of student’s social security card


If necessary, record of guardianship


Once all required documentation is submitted, it will be passed to the ICRE-R Admission Review Committee for evaluation. The committee may accept and notify eligible students up to one year prior to completing the high school credentials. Applications must be received in full no later than March 31st of the school year prior to admission.

Students accepted to the ICRE-R Transition Program will complete a 45 day trial period.

Sincerely yours,

Susan Devitt
ICRE-R Admissions
1950 West Roosevelt Road
Chicago, IL 60608




ICRE-R Transition Program 10-4



Immunization Record IL444-4737-1

Release of information Medical

Free of CD letter Medical-1

Release of information Education