HMIS New User Request Form

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It is important to the Rhode Island Coalition for the Homeless to ensure all HMIS processes and procedures are streamlined. When a volunteer or staff member in an already-participating RI-HMIS organization is in need of HMIS access, this form should be completed. If you are not a participating RI-HMIS organization, please contact hmis@rihomeless.org for more information.

Please note: Staff will not be granted HMIS access until confirmation that the organization requesting a license has paid for said license. If you would like a staff member to replace the pre-existing access another staff member may have, you can indicate that in this form. If there is more than one user on HMIS that no longer need/use the system and you’d like to free up that license, please contact the HMIS team at the email listed above.

Billing Period for HMIS License Year: July 1st - June 30th
Any new licenses bought during this billing year will be full-cost and need to be renewed come July 1st the following year.

Note: Licenses are not attached to people, but rather through the organization. No HMIS license should ever be shared. Each license can only be used by one user at a time.

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Agency Name: *

Who is submitting this form? (Name & Email) *

Name of New User: *

Why does this new user need HMIS access? (Please list all of the user's responsibilities in HMIS like data entry, reviewing DQ, data cleanup, CES access, etc.) *

Work Email *

Office Number *

Title/Position *

What access role does the new user need in Clarity? *Additional access roles require training. Please refer to the Training FAQ for more information.* *

Agency Staff - primarily for end-users who are required to enter or cleanup data under their Home Agency

Read Only - primarily for end-users who do not enter data into the HMIS

HMIS Manager - primarily for end-users who hold the “Agency HMIS Manager” position with their agency

Please list the Clarity Program Name(s) this new user will be viewing/entering data for? (Please provide exact full program name as it appears in Clarity for access) *

Has this individual been a licensed user on HMIS in Rhode Island within the last 12 months? *

Yes

What type of license is being requested? *

I can confirm that there is a license available that's already been paid for.

An additional license will need to be invoiced to my agency.

Küldés

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