Student Resources
Background Check
Instructions for Completing Forms
If you have been asked to have a criminal background check done in preparation for placement in fieldwork or a clinical internship, you must follow these instructions:
1. Print this instruction sheet for reference. Then print these three forms:
2. Authorization and Release Form - Sign your name, date the form, print your name and include the name of your major or student classification.
3. Background Information Disclosure Form - Fill in the personal information on the top of the form and then answer all applicable questions on Sections A, B, and C. Add your signature and date at the bottom of page two.
4. Wisconsin Criminal History Single Name Record Request Form - Complete the center information in blocked area with heading of "Search for a Record on:" Be sure to add all other identifying information, as it will reduce errors that might take place in the search.
5. Bring all of your completed forms to Andrea Cheney, Merrill Hall, Room 115. If you would prefer to mail or FAX the forms, send them to:
Debra Archie, Program Assistant
UW-Milwaukee
College of Health Sciences
P.O.Box 413
Milwaukee, WI 53201
FAX: 414 229-2206
