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April 24, 2019

Childcare - Request an IRIS Account

Complete the IRIS request below only if you are a childcare provider needing IRIS access. All required fields marked with an asterisk (*) must be completed in order for your request to be processed.

Please note, after submitting the online request you will receive an email with a copy of the information you submitted. This email will be your confirmation that your request was submitted to our program successfully and that we are working to process it as quickly as possible.

Are you an existing IRIS user?:*
Yes
No

If yes, what is your IRIS username?:

First & Last Name:*

Job Title:

Email:*

Name of Childcare Facility:*

Type of Childcare:*
Public
Private

Type of childcare license:*
City Licensed
State Licensed
Not Licensed

Facility Mailing Address:*

City:*

Zip Code:*

County:*

Childcare Phone Number:*

Add Additional Users

Additional 1 (First, Last and Title):

Additional 2 (First, Last and Title):

Additional 3 (First, Last and Title):

Submit

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