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HMIS Project Set-Up Request Form

HMIS Project Set-Up Tool

This form is to be sent whenever a new project in HMIS needs to be set-up; this request will be received by the HMIS Team. If you are requesting a change in an already existing project, please complete this form as well and indicate at the end the necessary information the HMIS office needs to transition your project.

Please complete your contact information below along with all project information requested. Incomplete forms will not be accepted. Please upload the projects' application and the contract at the end of this document. Without the contract and application, your request may not be considered. 

Note: A project set-up request does not guarantee that the project will be set up. If more information is needed by the HMIS team, we will reach out to the contact person listed in the form. If there are questions you are unable to answer on this form or need some help walking through this form, feel free to give us a call at (401 )721-5685 ext. 25,
1. Please provide your information as program set-up requestor.  *This question is required.
4. Who is the Contact for Referrals to this Project?  *This question is required.
5. Who is the HMIS-Agency Administrator who should be contacted in regards to Data Quality in HMIS for this Project? *This question is required.
6. Target Population (i.e. Families, Adult Woman, Adult Males, Youth...etc.) *This question is required.
This question requires a valid date format of MM/DD/YYYY.
calendar
This question requires a valid date format of MM/DD/YYYY.
calendar
13. What kind of funding source(s) does this project receive?
(Please select all that apply). *This question is required.
This question requires a valid number format.
This question requires a valid number format.
17. Of the total beds you have in your available units, how many total beds are dedicated for individuals, youth (13-24) or families? *This question is required.
19. If CH Dedicated or DedicatedPLUS, how many beds do you have for each? *This question is required.
21. Please upload a copy of your projects' application.
Project set-up may not be approved without this. 
22. Please upload a copy of your projects' approved contract.
Project set-up may not be approved without this.