HMIS New Provider Set up

Use this form to request a new provider set up in DC's HMIS. Please allow 1 week from completed submission for the set up to be completed. If you have questions, contact the HMIS Helpdesk at hmis@community-partnership.org

Email Address*

This is the email address of the person completing this form

Name of Agency*

If your agency does not appear in this list please contact HMIS@community-partnership.org

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Name of Program*

Address of Program (including zip code)*

Type of Address provided*

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Program's Point of Contact Name*

This is the person we will contact with any questions about the program including but not limited to vacancies, grant information, and CAHP participation.

Program's Point of Contact email address*

Date program began serving clients/will begin serving clients*

Population Served*

If your program will serve more than one of these options, we will likely need to create multiple providers in HMIS. Complete this form for each population you will serve with this program. Contact HMIS@community-partnership.org with questions.

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Program Type*

If you are unsure what type your program is please refer to this definition document: https://drive.google.com/open?id=1Ny7BSpkjJu1_1CFJgGCP-7XkUGEMnE4V

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Availability of shelter*

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Bed Type*

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For single individuals programs, number of beds

For Family programs, number of units

For Family programs, average household size

Housing Type*

Select or enter value

Number of Beds/units for Chronically Homeless Veterans*

Number of beds/units for Youth (18-24) veterans*

Number of beds/units for any other veterans*

Number of beds/units for Chronically Homeless Youth*

Number of beds/units for any other Youth*

Number of beds/units for any other Chronically Homeless people*

Non-dedicated beds/units*

Funding Source for program*

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If Federally funded, grant identifier

Grant Start Date*

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