SIPA Service Request Form

SIPA Service Request Form

Statewide Internet Portal Authority

Please complete the following form to request a single service from the Statewide Internet Portal Authority.

If at any time you need assistance completing this form, please email sipa@cosipa.gov or call (720) 409-5634.

Contact Information

Date of Request

Date Service Needed

Is there a mandated or legal requirement for this project?

YesNo

Entity Name

Entity Type

Entity Website URL

Requestor First Name

Requestor Last Name

Requestor Title

Requestor Phone

Requestor Email

Project Sponsor First Name

The Project Sponsor has signing authority for the project.

Project Sponsor Last Name

Project Sponsor Title

Project Sponsor Phone

Project Sponsor Email

Please briefly describe your project goals and requirements related to this service request

How did you hear about SIPA?

Service Requested

Please select the service being requested. Each service requires a separate form to be completed.

Affiniti Network AssureAODocsCall Center Solutions - Five9Cirrus Insight - Integrate e-mail inbox with SalesforceCloud ServicesCustom & Rapid Application Development- Web forms that take payments or custom applications that do not fit within other servicesCyber Security Assessment - Powered by IstonishDocuSign - Electronic Signature and Complete Digital Transaction ManagementGIS Professional ServiceEvent Registration - A solution for your event and meeting registrations. Collect payments and track registrationsForm Assembly - Online web forms that can work as a stand-alone or as a Salesforce Integration. Can include payment integration & signature.Google Applications - e-mail, calendar, contacts, docs, sites, drive and video. MyEvents2Go - Mobile conference agenda solution for iOS, Android, and Windows phonesMobile Payments - Accept credit card payments from mobile devices even if offlineMUNIRevs or LODGINGRevsOnline Video Streaming and Hosting - Granicus or Open Media FoundationPayment Integration - Connect our payment engine to your custom applicationPayment Processing - Accept credit/debit cards or electronic checks online and/or over the counterSalesforce.com - Platform as a Service, CRM and Community Management Tool, Application DevelopmentVirtru - Email EncryptionWebsite - Colorado.gov WebsiteOther - Please contact us at 720-409-5634 or sipa@cosipa.gov

Custom Application

Please describe in as much detail as possible, the custom application's features and functions being requested?

Please describe your current method, if any, for performing this process.

Please describe how this process will be improved by the implementation of the application requested.

Who is the end user or customer for the application?

Approximately how many users will be using this application?

Event Registration

For what type of events and how many different events are you requesting the Event Registration Tool?

Will you be collecting payment as part of your Event Registration Process?

YesNo

Payment Processing Information

Payment Processing Options - Please check all that apply

Accept Credit Cards OnlineAccept Credit Cards Over-the-CounterAccept Credit Cards on a Mobile DeviceAccept Electronic Check OnlineAccept Electronic Check Over-the-Counter

How are you currently collecting payments (manually, cashier, mail, etc.)?

What payment types do you plan to collect?

Will you require integration into the state accounting system (CORE)?

YesNoNot sure

What is the average transaction amount?

please put a $ amount here.

Please estimate the average number of transactions per year

Will you require integration with a 3rd party provider or application (e.g. court fines, utility payments, or other software, etc)?

Which 3rd Party Vendor will support your payment integration if needed?

What Bank/Financial Institution does your organization use?

In a given year, do you expect high or low transaction periods? Please explain.

How many Over-the-Counter Stations, if any, will you need?

For Over-the-Counter transactions, what Internet Browser will your staff be using. Please list all versions in use - i.e. Internet Explorer 11, Chrome 42, etc.

Salesforce.com

Please describe your Salesforce needs

New Salesforce ApplicationAdditional LicensesAdditional App Exchange ProductsService or Support AgreementOther

Please describe the solution needed - any requirements, number of licenses, timeline, alternatives, etc.

Google Applications

Which Google Applications are you interested in

Google Licenses (email, calendar, drive, sites, docs, video, etc.)Google Message EncryptionGoogle Vault (Message Archiving) Other Google Product (Maps, App Engine, etc)

What is your current email platform?

How many email accounts does your organization currently have?

Approximately how many licenses will you need?

Will you need help migrating from your current email platform to Google Apps?

YesNo

Learn more @ www.colorado.gov/sipa

Website

Requested Website URL? www.colorado.gov/<name>

please enter the last part of the URL, e.g. /sipa

What date would you like your new site to go live?

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Contact Information