St. Louis Partners CSWIS

Request for Access

This form is maintained as part of the User Access List.  Please complete all available fields.   This data will only be used to open your account and in the event you forget your password.  Passwords are not to be given to anyone.  No one from CFF Systems or St. Louis Partners will ever ask you for your password.     Your user id and default password will be e-mailed to you at the e-mail address you provide in block five (5) below.

1).   Date/Time of Request: 

2).  User's Full Name:

3).  Employer: Select Bringing Families Together Good Shepherd Children and Family Services Our Little Haven Lutheran Family and Childrens Services of Missouri

4).  User's Position:  Select Case Manager Supervisor Program Director Support Staff Resource Development Administrator Agency Director Quality Assurance Placement Specialist

5).  User's e-mail Address: 

6).  User's Phone Numbers:
          a).  Work Phone:     
          b).  Cell Phone:        

7).  User's FACESID: 

8).  User's Supervisor: 

9).  Supervisor's Email: 

10).  User's Agency Director:  

11).  Requester's Email (if different than Supervisor): 

Confidentiality Agreement

I am aware that when accessing St. Louis Partner's Client Management system, confidential information will be made available to me such as client lists and activities and provider lists/policies/costs.  I understand that this information is proprietary and critical to the success of St. Louis Partners and must not be given out or used outside of St. Louis Partner's premises or with non-St. Louis Partners employees.  I hereby agree not to utilize or exploit this information with any other individual or company.  Submission of this form constitutes agreement to these terms.

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