CORI Request Form
All volunteers and student interns should use this form when requesting a CORI check. For more information, please visit our website:

You must submit this form and then GO INTO the School and present your government issued photo ID and the last six digits of your Social Security number to the main office at the school you select as your primary location at least 5 business days before you will begin volunteering . If you do not go into the school your CORI cannot be processed without the verification of your ID.  A CORI background check is valid for three years.
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Email *
Daytime phone numer *
Select all locations that you will be assigned to (select all that apply) *
What school will you primarily be assigned to? (This is where you will bring your government issued photo ID to be verified by the front office admin assistant) *
What date is the CORI result needed? We need at least 1 week (5 business days) to process a CORI request. 
Select which best applies to you *
If you are volunteering, pleases select any specific programs that apply to you.
If other, please describe your role with LPS
If a contractor, what is the name of the company you work for?
Legal First Name *
Legal Last Name *
Middle Name
Maiden Name (or any other name(s) by which you have been known.)
Date of Birth *
Place of Birth *
Sex *
Height (ft) *
Height (in) *
Eye Color *
Race (optional)
Mother's Full Legal Maiden Name *
Father's Full Legal Name *
Current Street Number and Name *
Current City/Town *
Current State *
Current Zip Code *
Former/Most Recent Previous Street Number and Name
Former City/Town
Former State
Former Zip Code
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