CT HMIS – LMS Registration Form

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CT HMIS - LMS Registration Form

This form is for New LMS Users or CT HMIS USERS needing an additional role in CT HMIS. If you already have access to the LMS but not cthmis_train (our CaseWorthy Training Environment), there’s no need to fill out this form again. Simply complete the End User Agreement within the LMS and the help desk will provide one. If you receive an error stating your email has already been used, then your LMS account is likely deactivated due to inactivity. Please submit a ticket to reactivate your account.

Name(Required)

First Last

Email(Required)

Are you a NEW user requiring training to access the CT HMIS Database(Required)

Do you currently access CT HMIS or is this your first time you are trying to gain access? If you currently do not access CT HMIS, you are a New User.

(Provide Details)(Required)

Organization Name(Required)

Other Organization Name(Required)

Continuum of Care (CoC)(Required)

Job Role(Required)

Your Phone Number (Mobile Phone Preferred)(Required)

Your HMIS Data Coordinator's Email(Required)

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By submitting this form, you are consenting to receive marketing emails from: CTHMIS, 35 Philmack Drive, Suite B206, Middletown, CT, 06457, http://www.nutmegit.com. You can revoke your consent to receive emails at any time by using the SafeUnsubscribe® link, found at the bottom of every email. Emails are serviced by Constant Contact