EmailMe Form - Background Check System

Name *

First Middle Last Suffix

Address *

Street Address City State / Province / Region Postal / Zip Code Country / Region

Home Phone *

### - ### - ####

Cell Phone

### - ### - ####

Email *

Are you a Unit, District or Council volunteer? *

Unit

District

Council

District Name

Unit Type *

Unit Number *

Enter your four digit unit number. District or council volunteers enter 0527

BSA Membership Number

If you have a BSA Membership ID Number please enter it here.

Upload State Police Criminal Record Check

State Police Criminal Record Check Expire Date

Upload PA Child Abuse History Clearance

PA Child Abuse History Expire Date

Upload Volunteer Qualification Affidavit.

Pennsylvania residents only. West Virginia and Maryland Residents must complete the FBI Criminal Background Check.

Affidavit Expiration Date (Must be renewed every 5 years)

Upload FBI Criminal Background Check

FBI Background Check Expiration Date

Upload Youth Protection Training Certificate

Youth Protection Training Date

*

Acknowledgement

I understand that it is my responsibility to provide copies to my unit leadership or chartered organization.

Verification Number