KCS Chicago 2025 Census

1800 E Oakton St, Des Plaines, IL 60018 | census@kcschicago.com

Please provide the details for the head of household and family members.

Fields marked with * are required

1. Head of Household/Individual

First Name Last Name Family Name Email Address Phone Number

Marital Status

Married Unmarried / Widowed

Date of Birth

Month

Year

Street Address Apt # City State Zip Code

How many unmarried children would you like to add?

How many relatives living within your household (e.g., spouse's parents, siblings, etc.) would you like to add?