New Era RTC — Technology Support Request

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Request Submitted

Your request is pending QA review by Chermaene Mathis. You will receive an email confirmation shortly.

Your Information

Full Name * Please enter your full name.

Department * Please select your department.

New Era Email Address * Please enter a valid email.

Phone Number Optional

Service Type

What type of help do you need? * Please select a service type.

Priority Level

P1 — CriticalSystem down or PHI risk

P2 — HighMultiple staff affected

P3 — MediumSingle user or standard

P4 — LowNon-urgent / question

Request Details

Request Title *Short summary like an email subject line Please enter a request title.

Describe Your Request *1. What system or form? 2. What are you trying to do? 3. What's happening instead? Please describe your request.

Attachments Screenshots, PDFs, or documents · Max 10 MB each, up to 5 files 📎 Click to choose files or drag them here

A file is over 10 MB, or you selected more than 5 files. Please adjust your selection.

Compliance or Regulatory Requirement?

What happens next? Chermaene Mathis will review and approve before routing to the La Gente technology team.