Help Request for Non-UMDNJ Workforce/Students

Step 1. Your Contact Information 

( * =required)

First Name:* 
Middle Initial :
Last Name:* 

Institution: * 

(Please type the entire email address carefully.  We will send a response to the email address provided here.)

Email Address:*  (check accuracy)

Phone Number:* 

Step 2. Sponsor Information:

Your sponsor is the UMDNJ person requesting for you to take the course(s).

Sponsor First Name:*   
Last Name:*
Sponsor phone number:* 
Sponsor email:

Step 3. Select your course(s)

You must select at least one checkbox.

I do not need a course at this time.
EMTALA
Compliance Education
HIPAA
University Hospital Mandatory Compliance training

Step 4. Specify your request: 

Check all that apply. You must select at least one checkbox.

I do not need assistance at this time

Password:

I do not remember my password
I need my password reset

Registration:

I need registration help for an Office of Compliance and Corporate Integrity training course
I need registration help for UH Mandatory Training course
I took the course before 2009, and I need to get my records from the course

Content:

The course is not displaying properly

Quiz:

I can't find the link to the quiz (make sure you listed the course name)
Quiz is not "popping up"
Quiz not graded
I need more quiz attempts

Certificate:

I can't find my old certificate and need to print a new one
I need instructions for activating my course certificate
I need instructions for printing the course certificate
I need a certificate from an archived course

Other: please specify using the box below

Please provide additional information that will assist us in processing your request or troubleshooting the problem:

Step 5. Additional Information

Required: Birth Year (yyyy) and day (dd)
(used for password creation)

Required: Last four digits of Social Security Number:
(used for employment verification)

Step 6. Submit the form:

It may take a few seconds to receive a confirmation that the form was submitted. Please wait.

Problems submitting this form?  Call (732) 743-3344.