CRIMINAL HISTORY REPORT FORM

Dear Education Student


Security has become an issue for many school administrations. Schools are developing security plans to help ease safety concerns of parents. Many schools in our area require that anyone working with their students must complete the State of Indiana’s limited criminal background check. The Indiana State Police Department offers schools access to electronically receive a copy of criminal background checks through their website. The following waiver gives Valparaiso University permission to access the necessary information in order to complete your placement for field practica.

You may receive a copy of your criminal background check electronically for your field assignment. The criminal background check will not become a part of the student file and will be handled confidentially. The criminal background check document will be used to verify the necessary information required by school corporations to aid in the classroom. It is the student’s responsibility to provide the necessary documentation for the school administration.

You may contact Mrs. Angela Coleman, in the Education office, to retrieve a background check. There is a $7.00 fee for each background check. Only money orders will be accepted as payment. Mrs. Coleman is available Monday thru Friday, January 7th thru the 11th, from 8-11:00a.m. and Monday thru Thursday, January 14th thru 17th from 1-4:00p.m. Please submit the release along with the seven-dollar money order made payable to VU when you request a copy of the state report.

The Indiana Limited Criminal History check is valid for one year and will need to be up-dated each year. The criminal background check is also part of the process to apply for an Indiana (and most other states’) teaching license. A different waiver form is available for Indiana State Teacher license applicants.

Sincerely,

Valparaiso University , Department of Education
Professional Development and Placement Office


HOW TO FILL OUT A MONEY ORDER

  1. $7.00 is required for a criminal background check.
  2. Write the name of the person or company whom you wish to pay or the payee, pay to or pay to the order of line (please fill in Valparaiso University). Fill in this information right away so that the money order cannot be cashed by anybody else it’s lost or stolen.
  3. Fill in your name on the from, purchaser, sender or remitter line.
  4. Write in the addresses. Where it says purchaser’s address write in your address, not the address of the person or company you’re sending it to. If there is only one address field, write your address unless otherwise noted.
  5. Sign the money order. There may or may not be a place for you to sign the money order. If there is, it will be on the front of the money order, and it will be labeled as something like purchaser, signer for drawer, purchaser’s signature or simple signature. Do not sign the back of the money order, as this space is usually for the payee’s signature.
  6. Fill in the memo, C.O.D. number, re, or used for space. Not all money orders have this space, but if yours does write your account number with the company to which you are sending the money order or other identifying information so that they know what you are sending the money for. (Put Criminal Background Check).
  7. Keep your receipt. Your money order will either have a carbon copy underneath or a portion attached (usually to the side or top) that you can detach and keep for your records. This is your receipt, and you should keep it in case the money order is lost. This receipt will usually have a tracking number that you will need in order to check the status of the money order if any problem should arise. Without the receipt or tracking number you may have no way to verify that the money order was received or to obtain a refund if it is lost.