Note:

Organizations wishing to create multiple users should submit one form for each separate user.

Purpose:

This form is submitted to MHA by the school contact person to establish a new CAHS user.
Once completed and passwords have been issued by MHA, proceed with Training. After Training,
please complete the "Potential Partners" form. The "Suggestions for CAHS" form can be completed
at any time and returned to MHA.

Reference document:

Completion of this form requires selection of User Access level. Refer to the reference document titled "User Access Definitions" for background information.

Directions:

• Option 1: Complete form on-line and <Submit>.
• Option 2: Download the form in Microsoft Word, complete it, save it, and then attach to an email to CAHS@mhaonline.org
• Option 3: Print out this form, complete it, and then:
  • Submit via fax to 410-379-8239
  • Send via US Mail to MHA, 6820 Deerpath Road, Elkridge, MD 21075

Submitted by entity contact person:

Name:      

School:     

Phone:      

REQUIRED E-Mail Address:  
(If you do not include a valid e-mail address, your information will not go through —
even if it seems like it has. The e-mail address will be used only for purposes of
submitting this form; it will not be shared with or given to other people or organizations.)

For each new user, submit the following:

User First name:  

User Last name:  

User Access Level (select one):

     Administrator

     User

     View Only

User Phone number:  

User Fax number:      

User email address: