EmailMe Form - HVAA Coaches, Trainers, & Volunteers Form

HVAA Coaches, Trainers, & Volunteers Form

Mandatory Background Check Clearances & Requirements

Prior to your submission; please gather all of your pertinent documents.

CURRENT VOLUNTEERS: No expired reports will be accepted. If you need to renew your reports, please visit http://www.hvaa.net/coaches-corner/expired-clearances-your-next-steps

NEW VOLUNTEERS: For more information on which documents are needed please go to our website:
http://www.hvaa.net/coaches-corner/general-info/required-coaching-clearances

If you need assistance with your submission please email solicitor@hvaa.net today.

Today's Date: *
MM / DD / YYYY
Name *
First Last
Coach name or volunteer name only. No nicknames please.
Primary Email Address *
Confirm Your Email Address
(it should match the primary email address exactly) *
Primary Phone Number *
### - ### - ####
Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Select all the applicable sports will you be coaching or volunteering for at HVAA *
In-House Baseball
Travel Baseball
In-House Basketball
Travel Basketball
In-House Soccer
In-House Softball
Travel Softball
Travel Soccer is not listed here because EPYSA requires all Travel Soccer clearances to be submitted through a separate risk management portal of their own.
MANDATORY CLEARANCES FILE UPLOADS
All files can be submitted in the following formats:
.PDF
.JPG or .JPEG
.PNG
1. Submit Your PA State Police Criminal History Report (PATCH) *
Submit the application "REQUEST DATE" that is listed on the above PA State Police Criminal History (PATCH) document. *
MM / DD / YYYY
All reports must be from January 2018 or later. If the requested date is before January 2018 they will be expired in the new year for the 2023 season.
Submit the "EXPIRATION DATE" for your PA State Police Criminal History (PATCH) document. *
MM / DD / YYYY
Your clearances will expire 5 years from the "Request Date" listed on your report. For example, a report that has a request date of 1/1/2020 will have an expiration date of 1/1/2025.
2. Submit Your PA Child Welfare History Report (Child Abuse) *
All reports must be from January 2018 or later. If the requested date is before January 2018 they will be expired in the new year for the 2023 season.
Submit the application "VERIFICATION DATE" that is listed on the above PA Child Welfare History (Child Abuse Report) document. *
MM / DD / YYYY
Submit the "EXPIRATION DATE" for your PA Child Welfare History (Child Abuse Report) document. *
MM / DD / YYYY
Your clearances will expire 5 years from the "Verification Date" listed on your report. For example, a report that has a verification date of 1/1/2020 will have an expiration date of 1/1/2025.
3. Submit either a signed "Disclosure Statement Application for Volunteers" affidavit document with your signature and a witness signature OR your FBI Fingerprint Report.

If you have lived outside of PA in the last 10 years, an FBI Fingerprint report is required! If you have lived in PA for the last 10 years and are a volunteer, the affidavit form is sufficient. *
All reports must be from January 2018 or later. If the requested date is before January 2018 they will be expired in the new year for the 2023 season.
Submit the "DATE" that is listed on the date your Disclosure Statement form/affidavit was signed OR the "DATE" listed on your FBI Fingerprint Report. *
MM / DD / YYYY
Submit the "EXPIRATION DATE" for your FBI Fingerprint Report or affidavit. It will expire within 5 years of the date listed on the form. *
MM / DD / YYYY
Your clearances will expire 5 years from the "Verification Date" listed on your report. For example, a report that has a verification date of 1/1/2020 will have an expiration date of 1/1/2025.
4. Submit Your Heads Up Concussion Certificate. *
All reports must be from January 2018 or later. If the requested date is before January 2018 they will be expired in the new year for the 2023 season.
Submit the date that is listed on the above Heads Up Concussion certificate. *
MM / DD / YYYY
Submit the expiration date for your Heads Up Concussion document. *
MM / DD / YYYY
Your concussion certificate will expire 5 years from the date listed on your report. For example, a report that has a date of 1/1/2020 will have an expiration date of 1/1/2025.
I hereby swear or affirm that the information set forth above is true and correct to the best of my knowledge and belief. I
understand that, if the information is obtained that I am disqualified from service, I will be dismissed immediately. I also understand that I am signing an electronic document subject to penalty under Sections 4903 and 4904 of the Pennsylvania Criminal Code (false swearing and unsworn falsification). I understand that as part of my HVAA duties I will be responsible for the welfare of children and/or will have direct contact with children. *
By clicking here I acknowledge the above statement.
SIGN HERE:

This is my electronic signature and I affirm that all my clearances and requirements are up-to-date and compliant with the PA Act 15.

All volunteers in PA must satisfy the requirements of the PA ACT 15 for child abuse screening/criminal background checks. (Clearances are good for 60 months only and will expire after that.) *
Clear
Unique ID

MANDATORY CLEARANCES FILE UPLOADS