Miami-Dade County Electronic 1628 ADMIN and/or USER Access Request Form

Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public records request, do not send electronic mail to this entity. Instead contact these offices by phone or in writing.

Requestor Information

First Name *

Last Name *

CTLS 1628 module training completion date *

Phone Number *

Job Title *

User Type *

Agency Information

Name of Agency *

Agency Phone Number *

Name of Point of Contact for the Agency *

E-mail of Point of Contact for the Agency *

Agency site number/s user requires access *

Enter Confirmation Number

Cancel