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Classroom Visitor Request Form

Instructions: 

  • Clearances submitted must be valid through the end of the current school year. (each school year ends June 30th and the next begins July 1st)
  • Please have all clearances saved digitally and individually, as they will need to be uploaded independently within the form where indicated. 
  • All copies of documentation must be authentic, clear and legible. 
  • We are requesting official and current clearances for: 
    • Mandated Reporter Certificate OR Nursing License
    • FBI Federal Background Check
    • PA Criminal Background Check
      • The Pennsylvania State Police’s EPATCH website can be used to apply for this clearance. 
    • PA Child Abuse History Certification. 
    • Valid copy of a government issued photo ID.
      • Accepted forms of government issued identification would be:
        • A State issued driver’s license
        • A State issued photo identification card
        • A U.S. Passport
  • If you expect to be visiting a classroom for more than 10 hours per week, we also will need a record of a negative Tuberculosis test within 3 months prior to your first classroom visit in an IU 20 classroom. 
  • We also need a valid email and phone number for the employee and their supervisor as well. 

TIPS: 

  • Please make sure all required information is filled out completely and accurately.
  • Please upload the formal certification form for each clearance document, and not a screenshot of the results summary page or transaction receipt.  
  • Expired clearances will not be accepted. (clearances are valid for five years from the date of certification on each document)
  • Names must match all documents submitted and be your current, legal name. 
  • All submissions remain confidential and are not shared. 
    • Contracted agency name, Employee's First and Last name as well as phone number and email address may be shared with CIU 20 staff and supervisors for communication purposes.


After the Submission:

The requestor will receive a formal “Clearance Verification” email to their email address provided. Please retain this clearance verification email and be prepared to display it to school staff who may request it upon arrival of your visit. Approvals are valid for the duration of the current school year only. 


Please be patient as this approval process is not instant and may take more than one business day to process and approve. You are not approved until you receive a formal notice that your request has been approved by the Colonial Intermediate Unit 20 Human Resources Department. 


Thank you for your understanding and cooperation keeping our children safe! 

Colonial IU 20 External Agency Contractors/Interns & 

Student Teachers/Observers Credentials Form

               This form is to be completed for any individuals providing services under an agency, completing internships, student teaching                         assignments, or observing in Colonial Intermediate Unit 20 Programs.                                                                                       

                                                

Name*
Supervisor's Name*
Student's Name (if known)

Certifications and or Licenses

Nursing License for RN's & LPN's*
No File Chosen
File uploads may not work on some mobile devices.
Date of RN LPN License*
Mandated Reporter Certificate *
No File Chosen
File uploads may not work on some mobile devices.
Date of issue Mandated Reporter Certificate*
FBI Federal Background Clearance *
No File Chosen
File uploads may not work on some mobile devices.
Date of issue FBI Federal Background Clearance*
PA State Criminal History Clearance*
No File Chosen
File uploads may not work on some mobile devices.
Date of issue PA State Criminal History Clearance*
PA Child Abuse Clearance*
No File Chosen
File uploads may not work on some mobile devices.
Date of issue PA Child Abuse Clearance*
PDE 6004 Arrest & Conviction Form
No File Chosen
File uploads may not work on some mobile devices.
TB Test Results*
No File Chosen
File uploads may not work on some mobile devices.
Please upload a state issued photo id*
No File Chosen
File uploads may not work on some mobile devices.

Location and Program

Please choose the site location(s) you will be working/observing at.
Please choose the program associated

Nursing Verification

HR Verification