Request for SIRS Username/Password (open)

Please use this form to request SIRS usernames and passwords for up to 5 staff members at your center who will need to use the SIRS web-based system, and to provide Operator contacts for email distribution.

Question details

1 Job Corps Center Name (Required)

2 New User Name (Required)

Last Name, First Name

3 Position on Center (Required)

4 Phone Number (Required)

Phone number and extension (if applicable)

5 Email Address (Required)

6 User Type (Required)

Advanced--These are users who may enter, approve, and submit a significant incident report.
Basic--These are users who may enter information but may not approve/submit a significant incident report.

Thank you for requesting a username/password for the SIR system. You will receive an email within 24 hours with new user information. Should you require immediate assistance, contact Christine Phoebus, 301-608-3290, ext. 309.

7 If you want to receive an email confirmation, please enter your email below (optional)

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Request for SIRS Username/Password (open)