Criminal Background Check Form
The State of Kentucky requires that any parent or volunteer, working with students and/or accompanying students on a field trip, have a Criminal Background Check completed. This background check will be valid for 1 calendar school year. In order to ensure that you can participate in field trips and volunteer opportunities, please completely fill out the request form. We are asking for $10 to offset the KY State processing fees. Cash or checks made out to Union Pointe Academy can be taken to the school office.
Your Name
*
First Name
Middle Name
Last Name
Your Maiden Name/Alias (separate each name with a comma)
List all children attending UPA
*
Relationship to student(s)
*
Email
*
Social Security Number
*
Date of Birth
*
-
Month
-
Day
Year
Drivers License Number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Form of Payment--$10.00
*
Cash (sent into school office)
Check (sent into school office)
To process your background check, please attach a copy of your driver's license. You may also send a copy to school or stop in the office to have a copy made.
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