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Pennsylvania Child Abuse History Clearance (DPW)
- Click here to download the Child Abuse History Clearance form.
- Print out the form.
- Complete Section I only.
- For applicant identification, please include:
- name, street, city, state, and ZIP code.
- Social security number
- Age
- Date of birth
- Daytime phone number
- Gender
- County where you live.
- For previous names, please include any name you can be identified as since 1975 such as maiden name, nickname, aliases, etc.
- For the purpose of clearance,
- If you are strictly a Parish volunteer, check Volunteers.
- If you are an employee for the school, check School.
- List your previous addresses since 1975. You may attach additional pages if necessary.
- List all household members that you have lived with since 1975 to the present. Please include the relationship with those members (such as mother, father, sibling, etc.).
- Sign the application and date it.
- Return this form to the Financial Secretary.
- You will receive the DPW in the mail (it takes approximately 2 weeks). This should be brought to the Financial Secretary.
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