Volunteer Criminal Disclosure Form
Please complete this form to provide information required for volunteering. All information will be kept confidential and used solely for volunteer screening purposes.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Volunteer Role or Activity Applying For
*
Have you ever been convicted of a criminal offense?
*
Yes
No
Are you currently subject to any pending criminal charges or investigations?
*
Yes
No
If you answered 'Yes' to either of the above, please provide details.
Signature
*
Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Submit
Should be Empty: