Background Check Release Form
Every candidate is required to have a background check ran before final approval for entering into the program. The cost of the background check is the responsibility of the potential student.

Please read through our SCREENING POLICY and
send in a $35.00 check, made out to The North Michigan District Of The Wesleyan Church
Send to:
Solon Center Wesleyan Church
ATTN: Rev. Chadrick Brown
15671 Algoma Ave.
Cedar Spring, MI 49319.

We cannot process your background check until we have received your check.

All information is confidential.

Social Security Number
Your answer
Date of Birth
Your answer
Your Name
First, Middle, Last
Your answer
Gender
Required
Race
Home Number
Your answer
Cell Number
Your answer
Email Address
Your answer
Current Home Address
Street, City, State, Zip Code
Your answer
Dates You Have Lived at Your Current Address
MM/DD/YYYY - MM/DD/YYYY
Your answer
Other Address That You Have Lived
Street, City, State, Zip Code
Your answer
Dates You Have Lived at Your Previous Address
MM/DD/YYYY - MM/DD/YYYY
Your answer
Name as it appears on License
Your answer
Drivers License Number
Your answer
State Issuing License
Your answer
Other names you have used.
Your answer
Signature
By typing your name below acts as your signature.
Your answer
Today's Date
MM
/
DD
/
YYYY
Submit
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