HMIS New User Registration

HMIS New User Registration

This registration form must be completed by the Agency HMIS Security Officer. User must complete training before HMIS access is granted. A printable version of this form is available upon completion and should be saved via digital or hard copy at the agency requesting access.
New User's Name

First NameLast Name
New User's Email
example@example.com
New User's Office Phone Number
Office Number PreferredFormat: (000) 000-0000.
New User's Title
New User's Program Name
New User's Agency Name
New User's Office Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please select the appropriate role(s) and database access for this user. For protection of all client data, LSNDC asks that users have access to only what is needed to perform their jobs. Answering these questions accurately ensures users receive proper training and system access.
Required Level Of HMIS Access:

Basic User - All UsersOther - LSNDC / ADMIN - Previous Approval OnlyPower User - Custom Reporting Access _ Previous Approval Only
Select every project type this user will enter data for:

Coordinated EntryEmergency ShelterDay ShelterHomelessness PreventionPermanent Supportive HousingRapid Re-HousingSafe HavenServices OnlyStreet OutreachTransitional HousingOther
Will this user record VI-SPDAT's in HMIS

YesNo
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.
HMIS Security Officer
HMIS Security Officer's Email
Date

MonthDayYear
Date
Signature
Should be Empty: