Wisconsin Custom Reports Request

Please complete the form below. Wisconsin HMIS staff will respond to requests within two business days with the estimated product delivery date. Report delivery times will vary depending on priority requests and other outstanding projects.

Basic Information

Name *

Name

First Name

Last Name

Agency *

Phone Number *

Phone Number

(###)

###

####

Email Address *

Taskforce/Workgroup

Does your agency currently use Wisconsin’s HMIS (also known as Wisconsin ServicePoint, or WISP)? *

Requested Report Delivery Date *

Requested Report Delivery Date

YYYY

Report Details

Is the data request for a specific grant? *

If the request is for data that will be used to complete a grant application, you must send a copy of the application to wisp@icalliances.org with the title 'Grant Application to Accompany Custom Data Request.'

Grant application due date (if applicable)

YYYY

What will this report be used for? *

Please provide specific details.

Which HMIS Provider(s) should be included in the report? *

Please provide as much of the following as possible: Provider Name, Provider ID Number, Program Name (if applicable), ServicePoint workflow type (Entry/exit, Service Transaction, or Shelter Stays)

Data elements or assessment questions to include: *

What do you want the report to count? *

What do you want the report to list? *

Report Start Date *

Report Start Date

YYYY

Report End Date *

Report End Date

YYYY

Provide any additional details that need to be included on the report

Wisconsin Custom Reports Request

Need Custom Data?