Santa Clara County HMIS New Program Request
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 address *
Requester's Name *
Please list a person whom Bitfocus may contact to gather more information, if it is needed.
Your answer
Q1) Agency Name *
Your answer
Q2) Program Name *
Your answer
Q3) Program Description *
Your answer
Q4) Federal Funding Source *
If none, select N/A
Q5) Grant Identifier
Your answer
Q6) Program Type *
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
Q9) Site Type *
In order to qualify as a "residential" the program you are requesting must be the one that provides the housing subsidy or directly manages a housing facility . If your program provides case management for clients in housing but does NOT provide the subsidy or directly manage a housing facility please select "Non-Residential" so that we do not inadvertently double count the beds in the system.
Q10) Target Population *
Q11) Victim Service Provider *
Q12) Zip Code & Project Address
Required for Shelter/Housing programs. If your project is a tenant-based,scattered site program you need only provide a zip code where the majority of tenants live. For other shelter/housing programs, please provide the address where the majority of the units are located.
Your answer
Q13) Housing Type *
Required for shelter/housing projects
Q14) Geocode *
Please choose the city where the program is located. If the city is not listed, please choose "069085 - Other Santa Clara County"
Responsible Staff Members
Optional. This person will receive email notifications from Clarity Human Services regarding clients referred to and/or enrolled in this program.
Your answer
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