Registration

	HRSA Electronic Handbooks for Applicants/Grantee

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Registration

You have started the registration process within HRSA EHBs. Note that registration is a two step process. Status of these two steps is shown below:

Registration Status

Step 1 of 2: User account creation is not complete.
Step 2 of 2: User account affiliation to an organization record is not complete.

Fields marked with an asterisk(*) are required.

STEP 1 OF 2: CREATE USER ACCOUNT

User Information
*First Name
Middle Initial
*Last Name
*Username	Username Requirements
*Password	Password Requirements
*Retype Password
*Security Question	More Information
*Security Answer

Contact Address
*Email Address
*Phone Number	() - Ext:
Fax Number	() -

Providing the address information below is optional. If you decide to provide the address then all fields marked with an "*" are required.

Physical Location Address (Optional) More Information

Domestic

*Street Address Line 1

Number	*Name

Street Address Line 2

Select one	Number

*City

(Required if Zip is not specified)

Urbanization

(Used only for Puerto Rico(PR))

*State

(Required if City is specified)

*Zip Code Lookup

- (Required if City is not specified)

International

*Street Address
(max length: 250 chars)

*City

Province
(max length: 50 chars)

Postal Code
(max length: 15 chars)

* Country

Providing the address information below is optional. If you decide to provide the address then all fields marked with an "*" are required. Please provide the mailing address if it is different from physical location address.

Mailing Address (Optional) More Information

Mailstop Code
(Internal Routing)

Division / Department Name

Domestic

Select an option (Street Address or PO Box Only or Rural Route)

*Street Address

Number	*Name

Select one	Number

*PO Box Only

Number

*Rural Route

*Type	*Number	*Box

*City

(Required if Zip is not specified)

Urbanization

(Used only for Puerto Rico(PR))

*State

(Required if City is specified)

*Zip Code Lookup

- (Required if City is not specified)

International

*Street Address
(max length: 250 chars)

*City

Province
(max length: 50 chars)

Postal Code
(max length: 15 chars)

* Country

Acceptable Use Policy