EMS Access Request Form
First Name
Please complete the form and click the submit button. You will be contacted by an EMS administrator with your EMS account information once your account has been created. There are software requirements that may need to be installed on your PC (the EMS administrator will let you know about this also).
Middle Initial
If no middle name, please leave this blank
Last Name
Department
Governor's Office
University
Alaska Housing
Administration
Law
Revenue
Education
Health & Social Svcs
Labor
Community & Econ
Military & Veteran Affairs
Natural Resources
Fish & Game
Public Safety
Environmental Conservation
Corrections
Transportation
Legislative Affairs
Alaska Court System
SOA Employee #
Phone
E-mail Address
Location (city)
I am replacing someone who had EMS Access.
If replacing someone who had EMS Access, please provide name: