HMIS New User Request

HMIS New User Request
Each Contributing Homeless Organization utilizing HMIS has an assigned HMIS Security Officer. This person is responsible for ensuring the agency is HMIS compliant and submitting HMIS new user requests. Only the assigned HMIS Security Officer should submit this request to Housing Forward. If you are unsure who this person is for your agency, please submit a help desk ticket to Housing Foward's Data Management & Reporting team by emailing help@housingforward.on.spiceworks.com for assistance so your request is not rejected or delayed.
Training Process

User Information
Name of User*

First NameLast Name
User's Agency E-mail*
This must be an agency email address. username@agency.org. Personal email addresses are not allowed to attached HMIS user accounts.
User's Phone Number*
Work numbers preferred
Title *
Name of HMIS Project(s)*
Agency Name*
Supervisor Email *
Supervisor will be notified of training progress updates
User Office Address*

Street Address

Street Address Line 2

CityState

Zip Code
Is this user transitioning to your organization from one where they were already active in ClientTrack?

No.Yes, this user is needing a new account with the same access as their previous organization.Yes, but this user needs access to both organizations.

Security Officer Information
I verify computer system setup including firewall, virus protection, full system scan, and appropriate web browser for this user. I approve and accept responsibility for this user’s access to the HMIS shared client information system. I attest that once this user no longer needs access to the HMIS system, I will notify the HMIS Team through the service request tool to remove user access.
Security Officer*
Today's Date*

MonthDayYear
Date
Security Officer Email*
You will receive a copy of this submission form.
Security Officer Signature*

Clear
This form should only be submitted by the HMIS Security Officer designated at your organization. If a submission is received by someone other than the agency's HMIS Security Officer, the request for training will be rejected and training delayed until your agency's HMIS Security Officer submits the proper request.
Should be Empty: