New Staff HMIS User Account Request

New Staff HMIS User Account Request Form

Add a new staff member to an existing HMIS User Account.

"*" indicates required fields

Agency Name*

Default Program (This should be the program the user will use most frequently)

Full Name*

First Last

Work Email Address*

Work Phone*

Have you completed the HMIS self paced training?*

Yes

Have you submitted the HMIS user agreement form?*

Yes

Should you have any additional enter data as? If so, please list the programs below.*