Missouri Alliance for Children and Families

Provider User Authentication Form

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 at the Missouri Alliance for Children and Families 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:

4).  User's Position: 

5).  User's e-mail Address: 

6).  CSWIS System Requesting Access To: 

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

8).  User's Supervisor: 

9).  User's Agency Director:  


Confidentiality Agreement

I am aware that when accessing Missouri Alliance for Children & Families, L.L.C., (MACF)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 MACF and must not be given out or used outside of MACF's premises or with non-MACF 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.