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
Documentation Guidelines for Teaching Physicians
Compliance Education
HIPAA Privacy
HIPAA Security
University Hospital Mandatory Compliance training (limited to UH volunteer faculty, physician or temporary employee)

Step 4. Specify your request: 

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

I do not need assistance at this time

WebCT ID/Password:

I need a WebCT ID
I do not remember my WebCT ID
I need my password reset

Registration:

I need registration help for an Office of Ethics and Compliance training course
I need registration help for UH Mandatory Training course
I keep getting an "illegal access" message
I am getting an "internal conflict in creating a course account" message
I took the course before 2004, 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.