HMIS New Project Request – The Planning Council

Please complete this form to request a new Project setup in HMIS. Fields marked with an asterisk (*) are required.

Agency*

Name of Agency Representative*

Email*

Project Name*

Which Continuum of Care (CoC) will the project be providing services in? (Please choose only one. If your project is multi-jurisdictional, separate projects must be set up within each CoC):*

Operating Start Date*

Federal Partner Funding Source*

Grant Identification Number

Grant Start Date

Grant End Date

Bed Inventory* (Please provide the total program capacity. If a prevention program please enter 0.)

ZIP Code* (Please enter the ZIP code for the program's location; if tenant based, please use the ZIP code where most of the units will be located.)

Household Type:*
Households without children (adults only)Households with at least one adult and one childHouseholds with only children

Project Type:*

Housing Type:*

Will the data entered into this project be shared with other providers in the system?*YesNo

If your agency is currently participating in HMIS, please list the first and last names of all HMIS users who will need access to this project within your agency (please enter “all” if the project should be open to all users). If not, please type in NA (new agencies must meet with the system administrator for training prior to setting up projects):*

Optional: If this project will be tracking Services provided to clients, please list which services should be in the Quicklist (i.e., Housing Counseling; Rent Payment Assistance, Rental Deposit, Utility Assistance, etc.):*

Please briefly describe the project:*

This form will be submitted to The Planning Council. We are currently experiencing a high volume of requests; please allow at least one week for this project setup to be completed. If you have any questions, you may call (757) 622-9268 ext. 3040.