/ When completed, this form should be sent to
Early Years Data Team, 3rd Floor East Cliff JDO, Preston,
PR13JT
Only original (and not faxed) versions of this application form can be accepted.
Incomplete forms will be returned to the applicant.

Request for access to the Children’s Centre MIS

*** Please note it is now mandatory for all new users to attend the Basic CCMIS training before a login is given. The training costs £25.00 per delegate ***

  1. New users should complete the form below and submit to the above address.
  2. The Business Support Team will contact new users to advise of the next available training session.
  3. Once delegates have attended a login will be granted.

Please give details about yourself and your place of work :

Last Name

First Name(s)

Job Title

1. Children’s Centre

2. Children’s Centre

3. Children’s Centre

4.Children's Centre

5.Children's Centre

Telephone (inc STD Code)

Email Address

Please give the following details:

Your network login ID (please state your email address if you do not have a network login ID)

The applicant accepts full responsibility for all system access under his/her login. Applicants should also be aware that an audit trail exists to record all system access and activity.

Signature of applicant

/

Date

To be completed by the Centre Manager / Head of Centre

Please tick correct Permission Level *

Read Only

/

Centre level

/ Multi Centre Level

Delete Function

/ One person per Children’s Centre only

Family Outcome Tracker

/ Please Tick Here For Access

Name (PLEASE PRINT CLEARLY)

/ Job Title

Signature of Centre Manager / Head of Centre

/

Date

Payment Information

I enclose a cheque made payable to LCC for £...... (insert amount)

Please invoice (if you require an invoice please tick and complete contact details above)

Please arrange journal transfer
Objective Code ………………………...... Subjective Code ……………………......

*

Read onlyCan see all records but can not edit or add data.

Centre levelCan edit and add records within one designated Children’s Centre

Multi Centre Level

Can edit and add records within more than one designated

Children’sCentre

Delete Function

Can delete records and all historical data relating to that record