Request for Student Observation Hours/Clearance
GUIDELINES:
 Observations will be authorized for a maximum of 3.75 hours per week without any additional requirement.
 Observation requests of 4 or more hours per week (maximum 16 hours) will require Livescan and TB clearance.
 TB Clearance: Must be within the last 6 months or obtain TB clearance prior to beginning observations from your physician.
 Livescan (fingerprinting): Must complete through RUSD. Please contact Kelly Powell, KPowell@rusd.k12.ca.us or (951) 788-7135, to schedule an appointment. The cost is $45.00. Payment must be in the form of a money order or cashier’s check.
 We CANNOT accept a Certificate of Clearance (COC) or livescan through any other agency to waive Livescan clearance.
 If you wish to work directly with students, please contact the school site to inquire about volunteering.
 All clearances are valid through the last day of the current school year. To remain on the observation list for the proceeding school year, you must notify HR no later than June 30th or your name will be removed and all clearances will need to be renewed.
 There is no guarantee that your request will be granted. Requests are filled at the discretion of the school site/department.
Email address *
Guideline Acknowledgement of Understanding *
Required
Date of Request: *
MM
/
DD
/
YYYY
Next
Never submit passwords through Google Forms.
This form was created inside of Riverside Unified School District.