Background Check Process for Parents/Volunteers LEVEL 2 Western School Corporation
**Please complete ONE FORM PER ADULT – NOT ONE FORM PER STUDENT**
While performing volunteer services for Western School Corporation, I am bound by the laws and policies which protect the privacy of student and staff information I am given access to. Such information or communications are protected pursuant to the Family Education Rights and Privacy Act (FERPA.) I agree to keep this information in the strictest confidence and the failure to do so may result in future volunteer/visitor opportunities being denied. I have read and understand the above CONFIDENTIALITY AGREEMENT: Sign and date below
I have read and understand the above CONFIDENTIALITY AGREEMENT: Type Name *
LEVEL 2 – Criminal History Check Authorization
Western School Corporation requires all LEVEL 2 Volunteer/Visitors to our schools during the school day who are under supervision of Western School Corporation staff to complete a limited criminal background check. Examples: Visiting for lunch, attending a special event (i.e. Awards Program.) This approval is valid for 1 school year with no charge to the volunteer/visitor.
First Name
Middle Name/Initial
Last Name
Date of Birth
MM
/
DD
/
YYYY
Phone Number
Student(s) Full Name
Signature
Today's Date
MM
/
DD
/
YYYY
Revised 7/15/19
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