Register Form


Information is available in English or Spanish. Acceso ala version en Español

To register for on-line access:

  • Complete the form below
  • Click the 'Submit Request' button
  • (Note: Dependents may not register for on-line access.)

Starred(*) fields are required

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  • Please enter your choice of Username and Password.
  • Your username must:

    • Contain 4 to 255 characters
    • It may consist of any combination of letters (A-Z) or numbers (0-9) or any of the following characters (~!@#$%^&*_+-=?)
  • Your password must:

    • Contain 14 to 255 characters
    • Include a letter (A-Z), a number (0-9) and atleast one of the following special characters (~!@#$%^&*_+-=?)
    • An uppercase and lowercase character
    • Your password may not contain any character repeated 3 or more times
    • Your password cannot contain a sequential sequence of characters or numbers of length 4 of greater.
  • Spaces are not valid characters for a username or password.
(ex. 555-555-5555)

Please choose a Security Question, enter your Security Answer, and optionally provide a Password Hint (to help remember your Security Answer.) The Security Question and Security Answer are used to reset your password.

Information above will be submitted via a secure connection to protect your confidentiality.