Santa Clara County HMIS New Program Request (2019-2020)
Please complete the following questions to set up your new program in HMIS. Once you submit this request, Bitfocus staff will follow up with you regarding any further questions and/or to confirm setup.
Email *
Requester's Name *
Please list a person whom Bitfocus may contact to gather more information, if it is needed.
Q1) Agency Name *
Q2) Program Name *
Q3) Grant Identifier
Q4) Federal Funding Source *
If no Federal Funding Source, select "N/A" or "Local or Other Funding Source"
Q5) Program Type *
Enter "0" for Bed or Unit Inventory (Q-25 & Q-26) if the program type is a Services Only, Homeless Prevention, or Street Outreach.
Q6) Street Address
Physical Location of Program or Administering Agency
Q7) Operating Start Date *
This is the earliest date that clients can be enrolled into the program, which may be sometime before the program is actually set up in HMIS depending on the timing and nature of your request.
MM
/
DD
/
YYYY
Q8) Operating End Date
Optional. Leave blank if program is not time limited.
MM
/
DD
/
YYYY
Q10) Target Population *
Q11) Housing Type *
Required for Shelter/Housing projects
Q12) Geocode *
Please choose the city where the program is located. If the city is not listed, please choose "069085 - Other Santa Clara County"
Q13) Program Description *
Q14) HMIS Participating Project *
(Optional) Responsible Staff Members
Optional. Responsible Staff Members- Enter the name and email address for one or more HMIS users at your agency to receive email notifications from Clarity Human Services regarding clients referred to and/or enrolled in this program.
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