Login Access Request

User Information

Please complete this section and accept the confidentiality agreement to request login credentials.

Name *

First

Last

Organization *

Title/Position *

County *

Project *

Phone Number *

Email Address *

Email

Confirm Email

Did you have dashboard access previously? *

What was your previous username? *

Level of Access *

Supervisor Information

The section below is to be filled by facility-level staff only.

Supervisor's Name *

First

Last

Supervisor's Title *

Supervisor's Phone Number *

Supervisor's Email Address *

Confidentiality Agreement

I acknowledge that the data to which I may be granted access is the property of the Ministry of Health of Kenya and is to be kept confidential. I agree that I will not transfer the use of my username or password to another person.

Agreement *

I agree