Certified Application

Application for Limited Background Check

Parent/Patron Volunteer & Visitor
Name (Legal name as it appears on your driver's license or social security card).*

First NameMiddle NameLast Name
Maiden Name (if applicable)
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail
Date of Birth*

MonthDayYear
Date
Place of Birth
Race (Select all that apply)

American Indian or AlaskanAsianBlack or African AmericanNative Hawaiian or Other Pacific IslanderWhite
Gender

FemaleMale
I need this background check for "*

ClassroomField TripSporting EventsContractorEmployment
School Name*

Rockville Elementary SchoolTurkey Run Elementary SchoolParke Heritage Middle SchoolParke Heritage High School
Date of application

MonthDayYear
Please list all your Children who attend NCP Schools.
Please list all your children who attend NCP Schools along with the school they attend. For Example: John Smith RES, Jane Smith PHHS
NOTE: NCP Corporation Policy Language on Criminal History Checks can be found in the NCP Policy Manual on the corporation website at this link
- By submitting a signed application for volunteer background request, the applicant is releasing the Corporation of any obligation should the volunteer become ill or recieve an injury as a result of his/her volunteer services.
- Please note, you may be asked by school officials for more data if requested by Indiana State Police.
Signature for Limited Background Check Application*

Clear
Should be Empty:

Application for Limited Background Check

Please list all your Children who attend NCP Schools.