Access Request Form

Instructions:  Only Criminal Justice personnel may apply.

Please complete all information.  If you omit any information your request will not be processed.  All information will be verified and all access requests are traced to their originating system.  Falsifying information is a criminal offense and any attempt to do so will result in a criminal investigation.  If you did not mean to request access please follow this link:    

After submission of this form you will be returned to the Offender Information home page.

First Name: Last Name:
Title or Role:
Email Address:
Department or Agency:
Departmental Address:
City: State: Zip Code:
Departmental Phone Number:
Departmental Contact to Verify Your Position:
Reason for Request: