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2. Miami County Communication Center
3. Law Enforcement Computer Access Request
5. Select One:*

   1. New

   1. Change

   1. Delete
9. Requests will only be accepted from the chief operating officer or their authorized designee.
   Please complete the form and click submit. The form will be sent to the Miami County Communication Center LEADS TAC/ Teri Newbright.
13. USER INFORMATION:
15. Previous or Current Spillman User?*

    1. Yes

    1. No
16. If yes, previous agency?
18. Full Legal Name (include Middle Initial):*
19. Date of Request:*
    Date of Request:

    Date of Request:
21. Ohio License Number:*
22. Current Agency:*
24. Home Address:*
25. Employee ID/Unit/Badge Number:*
27. Home/ Cell Number:*
28. Email:*
30. Agency Group(s) Needed:*
34. LEADS:
36. Currently Certified?*

    If yes, send copy to tnewbright@miamicountyohio.gov

    1. Yes

    1. No
37. Practioner Only?*

    1. Yes
    2. No
39. Non-Disclosure Agreement Completed?*

    1. Yes

    1. No
41. LEADS Testing Required?*

    1. Yes

    1. No

    If yes, see next question.
42. If Yes:

    1. Full Qualification
    2. CCH

    1. MDT Only
46. Agency (or Authorizing Agency):*
47. Title:*
49. Email:*
50. Date:*
52. Signature:*
56. Applications:*

    1. CAD
    2. Mobile

    1. State Link
    2. LEADS

    1. Touch
58. Purpose of Access:*
60. Notes/ Restrictions:
62. Background Check:

    1. Fingerprinted
63. Cleared By:
64. Date:
    Date:

    Date:
Leave This Blank:


66. 1. Receive an email copy of this form.
67. Email address

    This field is not part of the form submission.

68. Submit

* indicates a required field