Please complete the form below. Report delivery times will vary depending on priority requests and other outstanding projects. Report requests must be submitted at least a week before they are needed. The Southern Tier Homeless Coalition, (STHC) Board must review all external data requests for approval.

Basic Information

Requestor Name

First Name

Last Name

Requestor Phone Number

(###)

###

####

Requestor Email

Please select which entity is making the request

Select HMIS Agency

Does the report being requested include data from HMIS projects outside of your own agency?

Name of entity requeting data

Requested Report Delivery Date

YYYY

Purpose of Report Request

Objective of the Request / What will this report be used for?

Key Questions to be answered with this data. Please provide specific details.

Grant application due date (if applicable)

YYYY

Is the data request for a specific grant?

If the request is for data that will be used to complete a grant application, you must send a copy of the application to brandy.yant@icalliances.org with the title 'Grant Application to Accompany Custom Data Request.'

What are you trying to learn or key outcomes of interest?

Please provide specific details.

Target Subgroup, Data elements or assessment questions to include:

Would you prefer we count individuals and/or households?

What do you want the report to list?

Report Details

Which HMIS Provider(s) should be included in the report?

Please provide as much of the following as possible: Provider Name, Provider ID Number, Program Name (if applicable), ServicePoint workflow type (Entry/exit, Service Transaction, or Shelter Stays)

Contact Us