EIS Access/Removal Request and Staff Update Form

 

If you are a provider of services for children and youth affiliated with the Office of Child and Family Services, you should complete this form for:

 

  • Complete this form to request - staff access to EIS to perform data entry responsibilities
  • Complete this form to request - the removal  of access to EIS due to staff resignation or change in data entry responsibilities
  • Complete this form to request - EIS password reset
  • Complete this from to submit - changes in staff names, agency of employment, office location, phone number, or email.

.

I want to......
(select one)
Access Type:
(check all that apply)

CANS (Child Adolescent Needs and Strengths)
      Supervisor (for CANS use only)
      Administrative Support Staff (for CANS use only)
OCFS Reportable Events (including critical incident)
Transition to Adulthood


(If last name changed within the past 3 months)

(Your designation location)

(If changing locations)
Supervisor's Phone:
Supervisor's Email:
Supervisor's Location:
Comments: