Request for Background Check Form

  • This form is to be used to request background clearances for the following groups only: noncredit instructors (paid by supplemental contract on IUP payroll), and teaching associates.

    Full Legal Name

     
    /Initial
     

     


     


     

    (Be sure to include the @)
     

    Start Date

     

    ,

     


     

     


     

     
     

    Requestor's Information