A hand reviewing a checklist of next steps

Participant registration

Start with only what P.R.I.M.E. needs to review your request.

Submitting this form sends a registration directly to the secure Home Office PMIS review queue. Authorized intake and review staff will use your selected method to contact you. It does not enroll you in a program or create portal access. If approved, P.R.I.M.E. provides a one-time activation link before onboarding and enrollment begin.

Need help using this online form or an accessible communication format? Send a general inquiry and describe the support you need. Do not include sensitive documents.

Already approved and activated? Sign in to the participant portal.

About youLegal namePreferred nameDate of birth (only if needed for eligibility)EmailPhonePreferred communication

Privacy and permission

This registration goes only to the secure P.R.I.M.E. Home Office PMIS review queue. Authorized intake and review staff use it to assess eligibility, contact you safely, prevent duplicate records, document a decision, and—only if approved—begin account activation and onboarding. Submission does not guarantee enrollment. Do not enter Social Security numbers, bank information, passwords, identity documents, detailed clinical records, victim information, or complete court files.

I give P.R.I.M.E. permission to contact me using the method I selected about this registration. I understand how this registration will be used and have reviewed the Privacy Policy.

Contact and referralAddressCityStatePostal codeReferral sourceProgram of interestEmergency contact (optional)Brief eligibility or support information (do not enter Social Security numbers or detailed medical information)