SIS New User Access Request

Screening Information System (SIS)

Please fill out the mandatory fields below to complete your access request for Screening Information System (SIS)

Requestor's Name

Requestor’s Phone

Extn

Requestor's Email

Requestor's Organization/Agency/Facility
[Enter N/A If Unknown]

Choose the program area for which you require access

First Name

Last Name

Email Address

State Employee

Yes

Physical/Preferred Mailing Address

Physical

Preferred

Address 1

Address 2

City

State

Zip

Phone Number

Extn

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