EmailMe Form - Volunteer Background Check Submission

EmailMeForm

Name *
First Middle Last Suffix
Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code
Primary Phone *
### - ### - ####
Email *
BSA Membership Number
If you have a BSA Membership ID Number please enter it here to assist us with updating your record.
Volunteer Type *
Cub Scout Pack
Scouts BSA Troop for Boys
Scouts BSA Troop for Girls
Venturing Crew
Sea Scout Ship
Explorer Post
District Scouter
Council Scouter
Select based on your primary role in Scouting.
Unit Number
Enter your primary unit number using four characters. ie: Enter 3 as 0003. Enter 172 as 0172. Enter 2100 as 2100.
District *
Please select which Scouting District you are in. Visit www.colbsa.org/districts/districts.html to determine your district if it is unknown.
Other Memberships
Please list any other BSA unit or district of which you are a member.
State Police Clearance Date *
MM / DD / YYYY
Enter the effective date of your Report of Criminal History from the Pennsylvania State Police.
Child Abuse Clearance Date *
MM / DD / YYYY
Enter the effective date of your Report of Criminal History from the Pennsylvania Child Abuse History Clearance from the Pennsylvania State Police.
Disclosure Date or FBI Fingerprint Clearance Date *
MM / DD / YYYY
Enter the effective date of your Disclosure Statement for Volunteers OR the effective date of your FBI Fingerprint based Clearance.
State Police Clearance Upload *
Upload Report of Criminal History from the Pennsylvania State Police.
Upload Child Abuse Clearance *
Upload Child Abuse History Clearance from the Department of Human Services
Upload Disclosure Statement or FBI Fingerprint based Clearance *
Upload Disclosure Statement for Volunteers (must have resided in Pennsylvania for past 10 years) or FBI Clearance.