EmailMe Form - Volunteer Background Check Submission

Name *
First Middle Last Suffix
Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
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
Boy Scout Troop
Venturing Crew
Explorer Post
District Scouter
Council Scouter
Select based on your primary role in Scouting.
Unit Number
Enter your primary unit number using four digits - example: enter 3 as 0003; enter 172 as 0172; enter 2125 as 2125
District *
Please select which Scouting district you are in. Visit www.bucktail.org/Districts to determine your district if it is unknown. Select "Council" if you are a Council Scouter.
State Police Clearance Date
MM / DD / YYYY
Child Abuse Clearance Date
MM / DD / YYYY
Disclosure Statement Date
MM / DD / YYYY
Enter the effective date for your Disclosure Statement for Volunteers.
FBI Clearance Date
MM / DD / YYYY
Enter the effective date of your fingerprint-based FBI Criminal History Clearance.
State Police Clearance Upload
Upload Report of Criminal History from the Pennsylvania State Police (PDF format only)
Child Abuse Clearance Upload
Upload Child Abuse Clearance History from the Department of Human Services (PDF format only)
Disclosure Statement Upload
Upload Disclosure Statement for Volunteers (PDF format only)
FBI Clearance Upload
Upload the fingerprint-based FBI Criminal History Clearance (PDF format only)