Criminal Record Check

Please provide the following information in order that we may complete the required criminal record check. Results may take several weeks from the submission of this fonn.

First Name

Middle Name

Last Name

Social Security Number

Date of Birth

Sex

Race

I have been a resident of Pennsylvania since -------

Applicants who have resided in Pennsylvania less than 2 years prior to the first day of classes will be required to complete an FBI record check in addition to the Pennsylvania Record Check.

Aliases and/or Maiden Name

	First Name	Middle Name	Last Name
Alias #1
Alias #2
Alias #3

Applicants with a positive record will be contacted by the school.

If you have any questions, please call our toll-free number 1-888-282-7427.