MDHS (ECCDI) Support Request
Summary
(required)
Request Type
(required)
Get IT help
Set up VPN to the office
Get a guest wifi account
Fix an account problem
Request new hardware
Request new software
Emailed request
Onboard new employees
Request a new account
Request admin access
sd_customer_name
Select the best option:
(required)
I am an Applicant.
I am a Provider (Employer).
First Name
(required)
Last Name
(required)
ID Number
Applicant Email
(required)
Applicant Phone Number
(required)
Type of Issue
(required)
Appeal
Direct Incentive - Discrepancy in Payment
Direct Incentive - Payment Outside of 14 Day Window
Direct incentive - Request to Update Payment Method/Bank Information
Direct Incentives Program - General
Director Direct Incentive
Room Refresh Program
Scholarship Payment Program
School Age Reimbursement Program - General
School Age Reimbursement Program – Payment Outside of 14 Day Window
Start Up Cost Reimbursement Program
Technology
Summary of Issues:
(required)