Volunteer Clearances "*" indicates required fields Volunteer's InformationPlease complete the information below using your legal biographical information (as indicated on your clearance documents)First Name* Last Name* SuffixSr.Jr.IIIIIIVVGender*FemaleMaleDate of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Contact InformationEmail Address* Enter Email Confirm Email Call Back Number*This is the phone number that the Upper St. Clair School District will call if they have any questions for you.Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code AffiliationRole* School Volunteer Student Teacher or Observer Upper St. Clair School District Employee Contractor Contractor Name*Allegheny Intermediate Unit #3AramarkArchery ClubArmed Forces ClubArt ClubBaking to BenefitBand Parent AssociationBehavior SpecialistBest BuddiesBiology ClubBowling ClubBoyce MusicalBrownie TroopCereal ClubChess ClubChinese ClubChinese Yo Yo ClubConflict CountriesConstructionCreative Computer ClubCrew (Rowing)CrossroadsDaisy TroopData JamEisenhower ExtrasEngineering ClubEnvironmental Awareness & RecyclingEvery ChildExtended Day ServicesFall PlayFBLA (Future Business Leaders)Fencing ClubForensics (Speech & Debate)Fort Couch MusicalFrench ClubFreshman BaseballFreshTech IntegratedFuture Med ClubGay-Straight AllianceGerman ClubGirl Scout TroopGirl United GloballyGirls Reaching Out WorldwideGolf - after school programGreek ClubHigh School Spring MusicalInteractJapanese ClubKennedy School of DrivingKids Helping KidsLab RatzLatin ClubLaw ClubLibrary Media AssistantsMake-A-WishMake-up CrewMarching BandMatthews Bus CompanyMaxim Staffing SolutionsMiniTHON ClubMontage (Lit. Publication)Multi-Cultural ClubMural ClubMusic Production/Classic Rock ClubNova CareNPH (Nuestros Pequenos Hermanos)Occupational TherapyOdyssey of the MindOperation SmileParkway West CTCPEAQ Swim ClubPhysical TherapyPTO - BakerPTO - BoycePTO - EisenhowerPTO - Fort CouchPTO - High SchoolPTO - StreamsRefugee Outreach ClubRoboticsRock Climbing ClubRPG (Fantasy Role Play)Save the Bees ClubSchool DentistSchool PhysicianSilvis ArtSki ClubSpanish ClubSt. Clarion (Newspaper)Stage CrewSteel City Therapy LLCStock Market and Investment ClubStudent CouncilStudents Demand Action ClubSuper Smash BrothersTable Tennis ClubThai ClubTheaterThespian SocietyTransportationTri-M Music Honors ClubTutorUltimate FrisbeeUNICEF ClubUSC Esports TeamWatson InstituteWesley Family ServicesWorld Affairs ClubYearbook (Clairvoyant)Young Democrats of AmericaYoung LifeYoung Republicans- Other -Other Name* Pennsylvania Residency*I have lived in Pennsylvania for at least the last 10 consecutive years. Yes No Clearance DataThe following questions require information from your clearance forms. Please have these forms nearby when completing the information in this section.Pennsylvania Child Abuse History CertificationIf you have not completed your Act 151 Pennsylvania Child Abuse History Certification, go to this link: https://www.compass.state.pa.us/cwis/public/home Page 1 Pennsylvania Child Abuse History Certification - Verification Date* MM slash DD slash YYYY Pennsylvania State Police Response for Criminal Record CheckIf you have not completed your Act 34 Pennsylvania State Police Response for Criminal Record Check, go to this link: https://epatch.state.pa.us/Home.jsp Page 1 Pennsylvania State Police Response for Criminal Record Check - Date of Request* MM slash DD slash YYYY Act 114 Criminal History ReportIf you have not completed your Act 114 Criminal History Report go to this link: https://uenroll.identogo.com/workflows/1KG6ZJ The requirement to obtain the Act 114 Criminal History Report can be waived if the volunteer is unpaid, can prove that s/he has lived in Pennsylvania for at least 10 years, and signs a Disclosure Statement affirming that s/he did not commit certain crimes elsewhere. Volunteers who have not resided in Pennsylvania for the past 10 years but have obtained their Act 114 Criminal History Report since establishing residency are not required to obtain another Report but must provide a copy of it to the district. Page 1 Act 114 Criminal History Report - Date of Fingerprinting*Please provide the date on the approval letter you received from the Department of Human Services. MM slash DD slash YYYY Volunteer Disclosure StatementIf you have not completed the disclosure statement, go to this link: https://webinfo.uscsd.k12.pa.us/_schoolwires/district/pdf/volunteer-disclosure.pdf Page 1 Volunteer Disclosure Statement - Date of Certification* MM slash DD slash YYYY
