EmailMe Form - Volunteer Secure Upload Portal

Name *

First Last

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Email *

Phone *

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

State Police Clearance Date *

MM / DD / YYYY

Enter the effective date of your Report of Criminal History from the Pennsylvania State Police.

State Police Clearance Upload *

Upload Report of Criminal History from the Pennsylvania State Police. Choose your saved .PDF file from the state and click on the Upload button.

Child Abuse Clearance Date *

MM / DD / YYYY

Enter the Verification date of your Report of Criminal History from the Pennsylvania Child Abuse History Clearance from the Pennsylvania State Police.

Child Abuse Clearance Upload *

Choose your saved .PDF file from the PA Dept of Human Services and click on the Upload button.

Disclosure Date

MM / DD / YYYY

Enter the effective date of your Disclosure Statement for Volunteers.

FBI Clearance Date (If PA resident for less than 10 years)

MM / DD / YYYY

Enter the effective date of your Fingerprint based FBI Criminal History Clearance.

Disclosure Statement

Upload Disclosure Statement, if you have lived in PA continuously for the past 10 years.

FBI Clearance

Upload FBI Clearance if you have NOT lived in PA continuously for the past 10 years.