This article provides guidance on how to fill out the Affiliate Account Form, which is used to create or restore user accounts for IT Consultants or Outsource Vendors (COA Service Contracts excluding local temps). The process of setting up an affiliate account takes a minimum of one week, so please plan accordingly.

To ensure a smooth onboarding experience, please complete the Non-Employee Affiliate Account Request form at least one week before the affiliate staff member's arrival. Please fill out the designated fields in the form with the necessary details to submit an Affiliate Account Request for an IT Consultant or Outsource Vendor.

NOTE:  Before starting, please note that fields marked with an asterisk (*) are required. Once the form is complete, the information will be sent to the COA Coordinator.

Affiliate Account Form Fields

1. Affiliate Role*: The role that best describes what the affiliate will be doing at Children’s of Alabama.
2. Legal Name of Non-Children's Learner or Affiliate*: The affiliate’s given name as listed on their legal id.
3. Preferred Name or Goes By Name: The name the affiliate wishes to be referenced by.
4. Affiliate Work or School Email Address*: The email address where the affiliate will receive email notifications from COA.  This can be a personal email if a school or work email is not available. 
5. Affiliate’s Organization or School*: Be sure to enter the name of the organization or school where the affiliate works or attends.
6. Work Location*: The work location for the affiliate (Onsite or Offsite Remotely).
7. Federal CMS Mandate Acknowledgement*: Acknowledge that you understand the requirements of the Federal CMS Mandate.
8. Children’s Systems/Training Needed: COA Systems, application, and training needed for the affiliate to perform their role assignment.
9. System Access Acknowledgement*: Acknowledge that you understand that you may be required to complete online training and submit a request for access form.
10. Is the Children’s email account needed?*: If the role of the affiliate will supplement staff, a COA email address will be needed.  Short student rotations will not have an email with COA. 
11. Will the affiliate be scheduled to cover shifts to supplement staffing*? If the affiliate will be covering scheduled staff shifts, select Yes.
12. Patient Care Role: Select whether the affiliate will provide direct or indirect care to the patient. If the affiliate will not be providing any type of patient care, select “No patient care”.
13. If returning, former role at Children’s: If the affiliate is returning to COA, select the former role for the affiliate.
14. Former Children’s ID Number: If the affiliate is returning to COA, enter the COA ID Number that was previously assigned.
15. UAB Blazer ID: AD Account assigned to staff and students of UAB.
16. Affiliate Base or School Location*: The city and state of the affiliate’s organization or school.
17. Date Joining COA*: The beginning date for the affiliate assignment.
18. Date Leaving COA*: The end date for the affiliate assignment.
19. Affiliate Identifier: Enter the social security number or date of birth.  This data is used only to prevent duplicate accounts and is stored securely not shared.  Be sure to enter all nine digits of the social security number or month, date, and year of birthdate.
20. Licensure*: Select the affiliate licensure, for example, Respiratory therapist.
21. RPN/LPN Licensure #: ID number assigned to an RPN or LPN licensure.
22. Children’s Organization Unit Name (Org Unit): Select the affiliate’s organization unit for Children’s of Alabama.
23. Children’s Coordinator Email*: Enter the email address for the COA Coordinator they will be working with (typically the person who will assign training and approve system access).
24. Affiliate Type Requested*: Select the affiliate type.
25. Affiliate Role or Function at Children’s*: Enter the affiliate’s role at COA.  Use a descriptive title as this will be sent over for badge printing. 
26. Non-Children’s Supervisor or Coordinator* First and last name of the supervisor or coordinator at the affiliate’s work or school organization.
27. Non-Children’s Supervisor or Coordinator Email*: Be sure to enter the email address of the supervisors or coordinator at the affiliate’s work or school organization.
28. Special Considerations: Enter any additional information related to the affiliate requirements, role, security, or other pertinent information related to this request.
29. Click the Submit button. Your request will be routed to the correct group to complete the setup in Infor.