• Non-Employee Affiliate Account Request

    Non-Employee Affiliate Account Request

  • This is a request to add or reactivate a user account for affilates who will access COA network or systems. This will include non-employee affiliates, such as: students, outside learners, temporary, agency, contract or staff supplement. For more about the process read this article: Affiliate Request Process 

    Please submit the request about a week in advance of arrival at our facilities to ensure a smooth arrival. Once processed, the Children's coordinator will be notified of the affilate's network ID. There are additional forms needed for a badge, clincial system access and policy acknowledgments.   

    Please note: This form should not be used for any role that will be paid directly from Children's payroll. If an employee requires a secondary role affiliate, please explain in detail in the comment box below. 

    Form instructions can be found at Affiliate Account Form Instructions. Please send any questions regarding this form to hris@childrensal.org. 

  • This form is not used for the selected role.  Please use the information below to locate the information you need.

    • MD Student, Fellow and Resident Rotations register at Clinical Apps Request Registration
    • Contact Info 
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    • Infor Affiliate Registration Required Below 


    • The new user setup process typically takes about a week to complete the full process.  This includes adding a user profile, setting up the network account, assigning any role based training needed, completing training, specific system access requests approved after training and full system access being granted.  

    •  - -Pick a Date
    •  - -Pick a Date

    • All affiliates must provide the identification data below marked *.  This is only used for account password reset and to prevent duplicate accounts for the same person.  

    •  - -Pick a Date

    • NOT VALID TO SUBMIT - You must provide a Children's of Alabama email address as your Children's Coodinator above.  Your COA contact person will be notifed of this request.  

    • NOT VALID TO SUBMIT - You must provide a contact email address from your organization as your Non-Children's Coodinator.  Your contact person will be notifed of this request. 

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