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 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. Bring all of your completed forms to the Office of Student Affairs, Northwest Quadrant Building B, Room 6425. If you would prefer to mail or FAX the forms, send them to:

College of Health Sciences
P.O.Box 413
Milwaukee, WI 53201
FAX: (414) 229-3373

For those students that have lived outside of Wisconsin within the past three years, you MUST complete the Applicant Consent and Disclosure form as well in order for an out-of-state background check to be completed. Be sure to list all addresses covering the last 7 years and remember to sign the form.