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Parent Volunteer Criminal Background Form

Northwest Allen County Schools

Limited Criminal Background Check

Northwest Allen County Schools requires a limited Criminal History Background Check as well as a copy of a driver's license for all volunteers working in our school in any capacity at any time during the school year. If you will be working in a classroom, volunteering on a field trip or working with students in anyway, you are required to complete this form and return it to school with your child.

Please print and use your full LEGAL name.

Last Name: __________________________________ First Name:_______________________________________ Middle:_______________________________________

Date of Birth: _______________________ Gender: _______ Race: ________

Student's Name(s): ____________________________________________________________________________

Grade(s) and Teacher(s): _______________ ________________________________________________________

Your relationship to student:______________________________

Are you currently a Northwest Allen County School employee? Yes No

If yes, what building do you work in?_____________________________

Are you currently a Northwest Allen County School substitute? Yes No

If yes, what position? Teacher Aide/Secretary Custodian/Matron

Food Service Nurse Bus Driver Other_______________________

Today's Date: ________________ Signature: ___________________________________________

Please submit this form along with a copy of your driver's license to your child's school.

Note: Background checks will only be run between August 1-20, and then again at the start of 2nd semester, between January 2-10.