THE ORGANIZATION
Contact Information
Organization name *
Organization website *
Primary contact name *
Primary contact email *
Primary contact role *
Explain your role and position within the organization.
Full-time equivalent/Membership head count *
If you are a post-secondary institution, please provide your full time equivalent (FTE) numbers. If you are an association, health organization, or have a health affiliation, please supply the number of staff served, or membership numbers.
Organization's mission/vision *
Please provide a summary of, or link to, your organization's mission and vision.
If you were unable to comply with all the statements above, or have questions regarding them, please use the space below for your questions or explanation.
What are your on-site STATIC IP addresses? (eg. 92.0.2.128-155 or 192.0.2.* or 192.0.2.155 )
Please format IP addresses as single IPs or IP ranges NOT as CIDR notation which the vendors do not accept.
If you have other information to provide for your onsite access to eHLbc resources, please enter it here.
i.e. through an organizational intranet, or through computers in a library space.
Off Site Access
If you selected more than one option above, or 'other', please explain how you intend to offer offsite access.
Please describe how often the logins are updated/expired (eg. yearly) and who manages them.
Does your website use HTTPS (Hypertext Transfer Protocol Secure) protocol for any Member-only accessible pages? Eg. on the page(s) you publish your database URLs/links.
Technical support contact name and title *
Technical Support email and phone number *
If you have any other comments or questions about technical support, please use the space below.
Use this space to provide more details or ask any questions that you may have.