"Ddds User Request Form" - Delaware

Ddds User Request Form is a legal document that was released by the Delaware Health and Social Services - a government authority operating within Delaware.

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DDDS User Request Form
Name of Provider Organization or DDDS Business Unit:
Add User
Upgrade to Supervisor
Terminate User
Indicate the ROLE this user should have in your organization (Check ALL that apply):
Instructor
Supervisor (Check the appropriate Sub-role below):
User Management
Enrollment Management
(includes Training Plans and Live Events)
Report Management
Skills Checklist Observer
Skills Checklist Data Entry ONLY
Learner
USER’S INFORMATION
First Name:
Last Name:
User Name:
(MUST be in email format – i.e.,
first.last@emailprovider.com
– recommend a LIVE email address)
EMAIL:
(if different than user name above)
USER CATEGORY (DDDS JOB CODE):
DESCRIPTION
JOB CODE
Check ALL That Apply
Administration/Directors
ADMIN
Administrative Support
ASP
Behavior Analyst
BA
Community Navigator
CNAV
Direct Support Professional
DSP
DSP Manager/Supervisor
DSP-M
Employment Navigator
EN
Employment Support Staff
ESP
Nursing
NUR
Program Oversight
PO
Shared Living Provider
SLP
Support Coordinator
SC
Transportation ONLY
TRN
Volunteer
VOL
DDDS User Request Form
Name of Provider Organization or DDDS Business Unit:
Add User
Upgrade to Supervisor
Terminate User
Indicate the ROLE this user should have in your organization (Check ALL that apply):
Instructor
Supervisor (Check the appropriate Sub-role below):
User Management
Enrollment Management
(includes Training Plans and Live Events)
Report Management
Skills Checklist Observer
Skills Checklist Data Entry ONLY
Learner
USER’S INFORMATION
First Name:
Last Name:
User Name:
(MUST be in email format – i.e.,
first.last@emailprovider.com
– recommend a LIVE email address)
EMAIL:
(if different than user name above)
USER CATEGORY (DDDS JOB CODE):
DESCRIPTION
JOB CODE
Check ALL That Apply
Administration/Directors
ADMIN
Administrative Support
ASP
Behavior Analyst
BA
Community Navigator
CNAV
Direct Support Professional
DSP
DSP Manager/Supervisor
DSP-M
Employment Navigator
EN
Employment Support Staff
ESP
Nursing
NUR
Program Oversight
PO
Shared Living Provider
SLP
Support Coordinator
SC
Transportation ONLY
TRN
Volunteer
VOL
DDDS User Request Form
TERMINATION DATE:
HIRE DATE:
THIS USER SHOULD BE RESTRICTED TO ONLY SPECIFIC IP ADDRESSES:
NO – allow to access from any device
YES – restrict this user to ONLY specific IP Addresses
IP ADDRESSES already provided to DDDS for entry in Relias
Please ADD the following IP ADDRESSES for my Organization
IP ADDRESS:
IP ADDRESS:
Name of Relias Training Supervisor submitting request:
Email address for Relias Training Supervisor:
Send completed form to DDDS_OPD_Questions@delaware.gov.
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