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SAMIS User ID Request Form
Use this form to request a user ID for access to the CSC Leon Services & Activities Management Information System (SAMIS).
You are required to first read the CSC Leon Data User Policy before requesting your ID. Click
here
to download the policy.
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* Indicates required question
Investment Program
*
Summer Enrichment
Family Strengthening
Youth Mentoring
Summer Special Needs Scholarships
Agency/Organization Name
*
Your answer
Program Name
*
Your answer
Your First & Last Name
*
Your answer
Access Email
*
Your answer
Your Supervisor's First & Last Name
*
Put n/a if you are the executive director/agency lead.
Your answer
Your Supervisor's Email
*
Put n/a if you are the executive director/agency lead.
Your answer
Which of the following are NOT authorized to use SAMIS?
*
Select all that apply.
Program Participants
Volunteers
Non Program Staff
Required
Have you read and agree to abide by the CSC Leon Data Security Policy.
*
Yes
No
Thank You!
Your request will be reviewed. If approved, you will receive an invitation to set up your user profile directly from the system. If you are not approved, a member of our team will be in touch.
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