Request to Close HMIS Program Form
Your Name
*
Your Email Address
*
example@example.com
Agency
*
Program to be closed (please use the program name as it appears in HMIS)
*
When did/will the program close?
*
-
Month
-
Day
Year
Date
Have all clients been exited from the program?
*
Yes
No
Unsure
Have you transferred clients from this program to any of your other programs (internal transfer)?
*
Yes
No
Unsure
If "yes," which program(s)
If "no," do you need help identifying resources for these clients (example: Coordinated Entry)?
Type option 1
Type option 2
Type option 3
Type option 4
Comments
Submit
Should be Empty: