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User Information
First Name:  
Middle Initial:
Last Name:  
System Access Information
Do you have a?:
Your email:  
Edison ID:  
Department Code:  
Administration enters department code value. If your department code is incorrect, please contact the help desk.
Do you have a State ID?:
TN State ID (RACF):  
Are you a?:

Contact Information
Phone Number : ( )      -            Extension:  
Contact details/Comments:
Do you work at a?:    
Contact/Trainer:    
Job Information
Current Job Title:   
Starting Date of Your Service
with TDHS or other agency:
   -  
Select the training/tests you are required to take:
Personal Information
Date of Birth:    -  
Gender:
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The information collected in this registration form will be used for purposes of reporting scores to appropriate administrative personnel. Demographic information may be used for purposes of validating tests, test formats, or test items, but user identities and other confidential identifying data will not be shared or used for other purposes.