Zenith Dashboard

Register Form

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

* Participant SSN

- or -

* Alternate ID

* First Name

* Last Name

* Date of Birth (MM/DD/YYYY)

/ /

* State

* ZIP Code

Please enter your choice of Username and Password.
Your username must contain 4 to 15 characters. It may consist of any combination of letters (A-Z) or numbers (0-9).
Your password must contain 8 to 12 characters and must include a letter (A-Z) and a number (0-9).
Spaces or punctuation are not valid characters for a username or password.

* Username * Password * Verify Password * E-mail * Mobile Phone (This may be used for text messaging. Standard text messaging rates may apply)

(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.

* Security Question * Security Answer * Password Hint
Information above will be submitted via a secure connection to protect your confidentiality.