Prospective New HMIS Projects

Agency Administrators and Leadership can use this form to alert the NCCEH Data Center to new Projects on HMIS. This should only be used by HMIS participating agencies. This is the first step in the process to confirm your project's information.

Agency Name

Is your Agency participating in HMIS right now?

Project Name

HMIS Project Type

CoC

NC-502

NC-503

NC-513

Other CoC

Counties

Does your agency have an active Agency Administrator?

What's an AA? Here's the HMIS Agency Admin Roles and Responsibilities: https://www.ncceh.org/files/11519/

Is this agency dedicated to serving survivors of domestic violence, sexual assault or human trafficking?

If yes, select VSP.

Does this agency use any of the following funding for agency-wide support?

Operating

When do you anticipate beginning to serve clients

Operating End Date

(If known)

Grant ID

External Sharing Needed?

HMIS Data Entry Start date

When do you anticipate having trained HMIS users entering data into the database? (may be different than when you start to serve clients)

Notes (optional)

Any special considerations, timelines, etc. needed as this request is processed?

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