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Request for Background Check Form

  • This form is to be used to request background clearances for contractors, volunteers, noncredit lecturers (paid by supplemental contract on IUP payroll); graduate assistants (not through the SGSA) and teaching associates ONLY.

    Full Legal Name

     
    /Initial
     

     


     


     

    (Be sure to include the @)
     

    Start Date

     

    ,

     


     

     


     

     
     

    Requestor's Information