Rev: 12/1/2014, Created: 4/13/2012
CombIS User Account Information Sheet
(For Consultant ONLY)	
This Information Sheet is to be completed by Consultant Project Manager/Certifying Engineer and submitted to NJDOT at County.CulvertInsp@dot.nj.gov as an e-mail attachment with the subject “CombIS:  Consultant User Account”.	
This information is for (check ONE): 	 Consultant hired by NJDOT    
 Consultant hired directly by Agency, County, or Muni./Local/Private  	
	
Consultant*:	     	Person Requesting:	     		
Project Name*:	     		
Group No.*:	     	State Project Manager*:	     		
	
 CREATE New CombIS User Account for Consultant:	
User Info:	
First Name*:	     	Last Name*:	     		
E-mail*:	     		
Role*:
(Check One ONLY)	 Team Member    Team Leader    Project Manager/Certifying Engineer    Other	
	
Address 1:	     		
Address 2:	     		
Address 3:	     		
City:	     	State:	     	Zip:	     		
	
Office Phone:	     	Mobile Phone:	     		
	
Reason for Creating New Account (Specify):
     	
 DELETE    EDIT
Existing CombIS User Account:	
First Name*:	     	Last Name*:	     		
Existing Role*:	     	E-mail*:	     		
New Role*:
In case of Edit only	     		
	
Reason for Deleting/Editing Existing Account (Specify):
     	
Comments:      	
*Required Fields