New Agency Registration

  • Please list up to four officers who can serve as approved contacts for the agency:

  • Please select a username and password. You only need to choose one username and password per agency.

  • This is the primary email account associated with the account. We allow agencies to register up to 4 officers so the email chosen here needs to be the primary form of contact.
  • Please read over the linked Agency Agreement for the Data Tracking & Agency Support Program and mark your agreement below. You must agree to the terms and conditions in order to participate in the Program. Please print a copy of this Agreement for your records.

    WVGHSP Data Tracking & Agency Support Agency Agreement