Security Clearances Required for Coaches and Commissioners

ZHAA is requiring all coaches and commissioners to complete both the State of Pennsylvania Criminal Background Check (PATCH; SP4-164) and Child Abuse Clearance (Act 33/34) application forms.

The criminal check (step 1 below) can be completed online via below link. This application takes about five minutes. The approved clearance notice can be printed immediately. (If you don't have access to a computer to complete the application online, you can download a printed form at top right and mail it to the state.)

Once received, the criminal check clearance must be submitted with, and attached to, the child abuse clearance application (downloadable in step 2 below or via second link at top right). The child abuse clearance must be submitted by mail and can take one month or longer to receive.

Please complete these forms as soon as possible.

After receiving both clearances from the state, coaches should submit their paperwork to their respective league commissioner in a sealed envelope. The paperwork will then be submitted to the Jackson Township Police Department where it will be kept on file.

Step 1:

Complete and print a Criminal History Request Form PA Criminal Records Checks (SP4-164)

Step 2:

Pennsylvania Child Abuse History Clearance Form (pdf)

Please read the instructions prior to downloading the form. To request a supply of the forms, please call (717) 783-6211.

1. Type or print clearly and neatly in ink Section I only.
2. Address must be Applicant's current home address.
3. All information must be completed in full. (The form asks for all previous names, addresses, and household members since 1975). This information must be provided to the best of your knowledge and belief. If necessary, attach additional pages.
4. Application must be signed.
5. Enclose a $10.00 money order for each application. No cash or personal checks accepted. Agency or business checks are acceptable.
6. Do not send any postage paid return envelopes.
7. Application should be placed in a business-sized or larger envelope prior to mailing.
8. One block must be checked for Purpose for Clearance. Do not check more than one block.
   
   

   Check the Volunteer Block if performing a service (paid or unpaid) for organizations such as Big Brothers/Big Sisters, Boy Scouts, Little League or churches. A copy of your Criminal Record Check results obtained within the past year must be attached. Do not send original Criminal Record results. If you are not a Pennsylvania resident, you must also attach a copy of your FBI results obtained within the past year. This block should not be checked for anyone volunteering in schools.
   
   Clearance results will be mailed to you within 14 days from the date that the clearance is received in our office. There will be no replacements after 90 days. Failure to comply with the above instructions will cause considerable delay.

Please contact the following for applicable criminal history requests:

• PA Criminal Record Checks (SP4 164): (717) 783-9973
• FBI Cards for School Employees (FD 258): (717) 783-3750

If you have trouble accessing this information you may obtain an alternative format by contacting the Office of Children Youth and Families at (717) 783-6211. You can also call (717) 783-6211 for clearance requests.