New HMIS Agency Request Form

New HMIS Agency Request Form

Thank you for your interest in becoming a community HMIS partner. In order to see approval for your agency to become a partner agency and sign the MOUs, etc. please answer the following questions:

Name of Community Organization/Agency or Government Department

Name of Requestor

Title of Requestor

Email Address of Requestor

What Organization Type is the best fit?

Select or enter value

Please list your primary funding source(s) type(s) and if you receive any government funding with requirements to enter in HMIS data? If so, what is the funding source name?

Briefly describe your organization/community group or agency.

Specifically, how does your organization provide services in relation to an equity-based decision making framework.

Please describe your staffing and training plan for ensuring data entered is inline with the HMIS Continuous Data Quality Improvement Plan and Partner Agency Privacy and Data Sharing Agreement (MOU).

Found on this webpage.

Would you have a specific project(s) under which your agency would be entering data into the HMIS? If so, please briefly describe below.

What does your agency do to end homelessness and address racial inequity and what is your approach to services?

How do you plan on using the information in HMIS? Such as program reports, client service and coordination, etc.?

Would you be entering in Coordinated Entry for All (CEA) Assessments?

Please provide 1-2 references that can speak either to your data entry processes or the services you provide.

Thank You!

As you consider your participation, I would recommend reading and understanding the requirements by reviewing the MOU. Although there is not a fee involved for participating, there is a commitment on staff time, data entry requirements, and training.Your request will be reviewed and we expect a response within 10 to 15 business days. Please feel free to contact Janelle Rothfolk, Data Asset Manager at the RHA at janelle.rothfolk@kchra.org with any questions or concerns you may have.

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