Vaccine Pre-Registration Portal

*UPDATE* February 9 - Registration is now closed.*

Welcome to the Bensenville COVID-19 vaccine pre-registration portal. This pre-registration portal is intended to identify Bensenville residents age 65 and older who are interested in the vaccine and to establish a means of communication with the Village of Bensenville for when doses of vaccine are available for these eligible populations. 

If you want to be considered for a vaccine, we need you to answer the following questions on or before 11:59 PM, Monday, February 8. There are a limited number of vaccines and you will be notified if you are selected to receive a vaccine. Completion of this form does not guarantee a vaccine appointment. Please do not come to receive a vaccine unless you have been contacted with a confirmed appointment time. Click the appropriate button below to link to the registration form.

This supply of the vaccine is extremely limited and will be distributed to Bensenville residents age 65 and older only. Unfortunately, due to the limited supplies, not all those who fill out the form will be able to receive the vaccine at this time. Age and residency will be verified.

If you have any questions, please contact vaccine@Bensenville.il.us. Additional information may be found at: https://www.dph.illinois.gov/covid19/vaccination-plan or on the Bensenville web site at www.bensenville.il.us . If you need further assistance you can call the Bensenville Library at 630-766-4642 between 9am and 5pm and a staff member will be able to assist you.