Limited Criminal History Consent (Level 2)
United Schools of Indianapolis (USI) schools are accountable for the safety and security of students during the school day. We take this responsibility very seriously. As part of our Charter Agreement, all USI school volunteers, employees and employees of contractors or subcontractors who have direct ongoing contact with USI students within the scope of their employment or through ongoing volunteerism in the building are subject to national, state and local criminal background checks to the fullest extent permitted under applicable law. USI reserves the right to make a determination whether a criminal history record is satisfactory or not.

I authorize United Schools of Indianapolis to obtain a limited criminal history report on my behalf, understanding that if United Schools of Indianapolis determines my criminal history record is unsatisfactory, I will not be permitted to have direct, ongoing contact with United Schools of Indianapolis students.
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Email *
Which school does your student attend? *
Student Name (First Last) *
Student's Teacher Name and Grade
Reason for Background check                                                             *
Guardian Name (First, Middle, Last) *
Date of Birth *
Race *
Gender *
Social Security number *
Current Address (Street, Apt #, City, Zip) *
Phone number *
E-mail Address *
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