Agency Partner Agreement

December 12, 2014

This form is an agreement between your agency and the WCICCC. Lori Sutton of the Illinois Institute for Rural Affairs at Western Illinois University acts as the HMIS Program/System Administrator on behalf of WCICCC. The form describes our mutual responsibilities in connection with the use of the HMIS database. It spells out many of the duties of the partner agency as a whole toward maintaining the confidentiality of client information. The Executive Director of your agency, or a person with similar responsibility, should read and sign this form. The form must be returned to WCICCC before your agency will be granted access to the HMIS database. You may mail the form to Lori Sutton, Illinois Institute for Rural Affairs, Western Illinois University, 511 Stipes Hall, Macomb IL, 61455.