Internal Request Forms – Methodist Home for Children

Please select the account type requested:

Would you like to also submit a hardware request at this time?

No
Yes

Account User Name and Contact Information

User Full Name*

Prefix First Middle Last Suffix

User Address*

Street Address Address Line 2 City NC ZIP Code

User's Cell Phone Contact Number

Is this cell phone MHC-owned or a personal device?*

MHC Owned Cell Phone
Employee Owned Cell Phone

User's Landline Contact Phone Number

Hire Date*

Please Note: IT department requests 7 business days advance notice to process and configure new accounts and hardware packages.

Department*

Job Title*

Supervisor or Manager Authorizing This Request*

First Last

Email Address of Supervisor or Manager Authorizing This Request*

DID Fax or Fax-to-Email account needed?*

No
Yes - New DID Fax Account Needed
Yes - Re-Assign an existing Fax Number to this User

Existing DID Fax Number to Re-Assign*

Current Owner of DID Fax Number Above*

First Last

Shared Folder Security

!Public Access Folders*

Advancement Shared Folder Group*

Clinical Shared Folder Group*

*Special Authorization Needed

Consumer Relations Shared Folder Group*

Corporate Services Shared Folder Group*

FACT Specialized Services Shared Folder Group*

Financials Shared Folder Group*

*Special Authorization Needed

Financials II Shared Folder Group*

*Special Authorization Needed

Foster Care Shared Folder Group*

Human Resources Shared Folder Group*

IFPS Shared Folder Group*

In-Home Shared Folder Group*

Early Childhood Services Shared Folder Group*

Leadership Shared Folder Group*

Marketing Shared Folder Group*

Recruitment Shared Folder Group*

Residential Services Shared Folder Group*

Staff Development Shared Folder Group*

Transitional Shared Folder Group*

Wilmington In-Home Shared Folder Group*

Hardware Request Detail

Cost Center*

Hardware Requested

Lenovo Laptop Package Detail

Microsoft Surface Package Detail

Cell Phone Selection

Business Justification for Hardware Requests

Notes

Did you notice any problems or omissions during the completion of this form that we can improve? Do you have any notes regarding the new account setup that we should be aware of?

Notes to SysAdmin

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008 President's Office
010 Administration
014 Consumer Relations
016 VP Program Services
017 Scholarships-Help
019 Training & Staff Development
026 North Hills Transitional Living Home
027 Craven Workforce Development Program
030 FACT Group Homes
032 FACT Day Treatment Program
037 7th District TFC (Nash)
038 WCHS Emergency Care
041 New Hanover Project
043 Wayne Family Preservation Community Commitment
044 Greene JCPC
045 Foster Care
047 Therapeutic Foster Care
048 Pitt TFC
050 Wilson/Nash/Edgecombe Tri-County Relocation TFC
051 Kinship TFC
052 Adoptions
056 Jordan Center
059 Pitt JCPC
060 Lenoir Transition/Re-Entry Family Preservation
061 Edgecombe Transition/Re-Entry IFPS
062 Wayne JCPC Family Preservation
063 Nash Transition/Re-Entry IFPS
064 Halifax Family Preservation
068 Hertford/North Hamp/Bertie Voc Job & Ed
070 Family Preservation - Region 10
073 Wilson Trans Re-Entry IFPS
077 Curtis Center
079 Western Area Multi-Purpose JCAC (Buncombe)
080 Advancement
081 Insight JCAC (Dillon/Butner)
082 Consultation & Program Development
083 Bridges JCAC (Forsyth)
084 Macon Multi-Purpose Home (Franklin)
085 Forsyth Transitional Living Home (Winston-Salem)
086 Hertford Multi-Purpose Home (Winton)
087 Chowan Multi-Purpose Home (Edenton)
088 Wayne Multi-Purpose Home (Goldsboro)
089 Craven Transitional Living Home (New Bern)
090 Robeson Multi-Purpose Home (Lumberton)
091 Union Multi-Purpose Home (Monroe)

MHC Systems Account and Hardware Request Form 2021

Account User Name and Contact Information

Shared Folder Security

Hardware Request Detail

Notes