EmailMeForm
ACT 15 (PA Volunteer Background Check)
Pennsylvania Dutch Council's Background Clearance Submission Portal
You will be asked to enter basic identifying information, including if you have one; enter the applicable dates for each document and upload the image of each document. You can enter, save, and go back to add additional information as it is necessary.
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Name
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First
Middle
Last
Suffix
Date of Birth
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MM
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DD
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YYYY
Address
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Street Address
City
State / Province / Region
Postal / Zip Code
Applicant's Email
*
State Police Clearance Date
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MM
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DD
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YYYY
Enter the effective date of your Report of Criminal History from the Pennsylvania State Police.
State Police Clearance Upload
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Upload Report of Criminal History from the Pennsylvania State Police (PDF, JPG, or JPEG formats only)
Child Abuse Clearance Date
*
MM
/
DD
/
YYYY
Enter the effective date of your Child Abuse Clearance History from the Pennsylvania Department of Human Services.
Child Abuse Clearance Upload
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Upload Child Abuse Clearance History from the Pennsylvania Department of Human Services (PDF, JPG, or JPEG formats only)
Has the volunteer been a resident of the Commonwealth of Pennsylvania for the entirety of the previous 10 years.
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Yes
No
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