Baltimore HMIS User Authorization
This form allows designated HMIS Representatives to authorize new users under their organization. Upon submission, the user will receive instructions to electronically sign the HMIS User Agreement. Once signed, the user will receive instructions to become certified. Once certified, they will receive their HMIS account information within 1-2 business days.
Your Organization
*
Your Name
*
First Name
Last Name
Your Email
*
example@example.com
Are you the HMIS Representative for your organization?
*
Yes
No
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User Information
Who is the person you wish to authorize to use HMIS?
User Name
*
First Name
Last Name
User Email
*
example@example.com
What sort of access does the user need?
*
Please Select
Data Entry
Read Only
Remove Access
Reason for Deactivation
Does user need Coordinated Entry training?
*
Please Select
Yes
No
Please describe the user's role and responsibilities in HMIS.
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Your Signature
*
By signing, you hereby authorize the above user to receive HMIS credentials contingent upon the user successfully completing their online certification.
Submit
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