Northwest Allen County Schools requires a limited Criminal History Background Check as well as a copy of a driver's license for all volunteers working in our school in any capacity at any time during the school year. If you will be working in a classroom, volunteering on a field trip or working with students in anyway, you are required to complete this form and return it to school with your child.

Last Name: __________________________________ First Name:_______________________________________ Middle:_______________________________________

Date of Birth: _______________________ Gender: _______ Race: ________

Student's Name(s): ____________________________________________________________________________

Grade(s) and Teacher(s): _______________ ________________________________________________________

Your relationship to student:______________________________

Are you currently a Northwest Allen County School employee? Yes No

If yes, what building do you work in?_____________________________

Are you currently a Northwest Allen County School substitute? Yes No

If yes, what position? Teacher Aide/Secretary Custodian/Matron

Food Service Nurse Bus Driver Other_______________________

Today's Date: ________________ Signature: ___________________________________________

Please submit this form along with a copy of your driver's license to your child's school.

Note: Background checks will only be run between August 1-20, and then again at the start of 2^nd semester, between January 2-10.