Children's Advocacy Center Providers

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Three forms are required for fingerprint-based criminal background checks for Children's Advocacy Centers.

Please note: Not all forms are compatible with Mac programs. Before you proceed, review the following information:

Instructions:
How to Complete Forms and Submit a Fingerprint-based Criminal Background Check


Form 1

Personal Authorization for Criminal History Record Information Inquiry (SFN 888)
(This form must be typed)

Additional Address History
(Use as needed and attach along with SFN 888 page 2)

Form 2
Criminal History Record Check Request Form (SFN 60688 - CAC)
(This form must be typed; Signature must be handwritten)

Form 3
Fingerprint Identity Verification (SFN 836)
(Print blank form)

If you have lived outside of North Dakota during the past five years, click on each state you have lived in (below) to see if you need to:

  • Complete additional out-of-state authorization forms for each state you have lived in,
  • Provide a copy of a valid photo ID or a copy of your social security card, and/or
  • Provide an extra set of fingerprint cards (must obtained from a law enforcement agency or an authorized third-party fingerprinting agency).

If any of the above are required, they must be mailed to the Bismarck office – Please DO NOT send anything directly to other states.

Individual State Background Check Forms

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Individual State Background Check Forms

Select from the list below. PLEASE READ ALL INSTRUCTIONS CAREFULLY!

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Alabama / Alaska / Arizona / Arkansas

Alabama

The signature on this form below must be witnessed.

Child Protective Services form (61kb pdf)

The signature on this form below must be witnessed by two people OR it can be notarized; an extra set of fingerprints cards are required; and a copy of a valid government issued photo ID is required.

Criminal History Record Information form (204kb pdf)


Alaska

Child Protective Services form (121kb pdf)

Criminal History Record Information form (1.71mb pdf)


Arizona

Child Protective Services form (153kb pdf)


Arkansas

  • Complete the form below - notary not necessary.
  • Due to their requirements, a second form will be generated by the CBCU and it will be emailed directly to you.
  • The online-generated form DOES require a notary.
  • Mail the completed form to the CBCU. Please Do NOT mail it to Arkansas.

Child Protective Services form (44kb pdf)

The signature on the form below must be notarized.

Criminal History Record Information form (748kb pdf)

California / Colorado / Connecticut

California

No forms are required.


Colorado

The form below must be typed. Photo ID required.

Child Protection Services form


Connecticut

On the form below, enter N/A in any field that does not apply to the applicant.

Child Protective Services form (192kb pdf)

Criminal History Record Information form

Delaware / Florida / Georgia / Hawaii

Delaware

  • Complete Part 1 before printing the form for signature and date.
  • If the applicant is under the age of 18, the form below must be signed by a parent or guardian.

Child Protective Services form (48kb pdf)

An extra set of fingerprints cards are required.

Criminal History Record Information form (748kb pdf)


Florida

Child Protective Services form (40kb pdf)


Georgia

No forms are required.


Hawaii

Child Protective Services form (24kb pdf)

Idaho / Illinois / Indiana / Iowa

Idaho

  • If the applicant is under the age of 18, the form below must be signed by a parent or guardian.
  • Signature must be notarized.

Child Protective Services form (2.61mb pdf)

Criminal History Record Information form


Illinois 

Child Protective Services form (415kb pdf)


Indiana

  • Online form required.
  • You will receive email instructions upon the department initiating a registry search.

Iowa

Criminal History Record Information form

Kansas / Kentucky / Louisiana

Kansas

  • Complete the Applicant Section on the form below
  • NO sections can be left blank.
  • Enter N/A if a section does not apply to the applicant.

Child Protective Services form (1017kb pdf)


Kentucky

  • Copy of valid photo ID is required. 
  • Provide a self-addressed, stamped envelope

Criminal History Records Request form (32kb pdf)


Louisiana

  • The form below is only required if the applicant is 18 years old or older
  • Requires copy of a valid photo ID

Child Protective Services form (1.15mb pdf)

An extra set of fingerprints cards are required.

Criminal History Record Information form (1.20mb pdf)

Maine / Maryland / Massachusetts / Michigan

Maine

  • Complete only if you are 18 yrs old or older.
  • This form CANNOT BE TYPED.

Child Protective Services form (130kb pdf)


Maryland

  • The form below must be typed
  • Signature requires a notary

Child Protective Services form (214kb pdf)


Massachusetts

This form below requires a copy of a valid photo ID.

Criminal History Record Information form


Michigan

A copy of a valid photo ID is required.

Child Protective Services form 

Minnesota / Mississippi / Missouri / Montana

Minnesota

  • The signature on the form below requires a notary.
  • If the applicant is under the age of 18, the applicant's parent or guardian will also need to sign AT THE SAME TIME IN FRONT OF NOTARY.

Child Protective Services form (64kb pdf)


Mississippi

  • Online form required
  • You will receive email instructions upon the department initiating a registry search
  • The signature on the form below must be notarized; requires copy of valid photo ID

Criminal History Record Information form 


Missouri

You will receive email instructions after the department receives your background check request.


Montana

  • The signature on the form below must be notarized.
  • If the applicant is under the age of 18, the applicant's parent or guardian must complete the Authorization for a Minor letter.
  • The parent or guardian signature must be notarized.

Child Protective Services form (95kb pdf)

Authorization for a Minor (103kb pdf)

Nebraska / Nevada / New Hampshire / New Jersey

Nebraska

  • The signature on the form below must be notarized.
  • If the applicant is not 20 years old or older, the applicant's parent or guardian must sign the form.

Child Protective Services form (168kb pdf)

The signature on the form below must be notarized.

Criminal History Record Information form (852kb pdf)


Nevada

A copy of a valid photo ID is required.

Child Protective Services form (76kb pdf)


New Hampshire

The signature on the form below requires a notary.

Child Protective Services form (49kb pdf)

  • The signature on the form below requires a notary
  • Self-addressed stamped envelope required.

Criminal History Record Information form 


New Jersey

Child Protective Services form (90kb pdf)

New Mexico / New York / North Carolina

New Mexico

Child Protective Services form (234kb pdf)

The signature on the form below requires a notary.

Criminal History Record Information form 


New York

The signature on the form below requires a notary.

Child Protective Services form (865kb pdf)


North Carolina

No forms are required.

Ohio / Oklahoma / Oregon

Ohio

No form is required.


Oklahoma

Child Protective Services form (173kb pdf)


Oregon

The form below must be typed.

Child Protective Services form (837kb Word docm)

Pennsylvania / Rhode Island / South Carolina / South Dakota

Pennsylvania

  • All sections of the form below must be completed.
  • If a section does not apply to the applicant, enter N/A.

Child Protective Services form


Rhode Island

  • The signature on the form below requires a notary
  • Copy of a valid photo ID is required.

Criminal History Record Information form 


South Carolina

You will receive email instructions after the department receives your background check request.


South Dakota

Complete the form below ONLY if the applicant has been the subject of a child abuse/neglect report in South Dakota.

Child Protective Services form 

An extra set of fingerprints cards are required.

Criminal History Record Information form 

Tennessee / Texas / Utah / Vermont / Virginia

Tennessee

No forms are required.


Texas

The signature on the form below requires a notary.

Child Protective Services form


Utah

A copy of a valid photo ID is required.

Child Protective Services form 

  • The form below requires fingerprints to be entered directly on the form
  • Copy of a valid photo ID is required.

Criminal History Record Information form 


Vermont

The signature on the form below requires a notary.

Child Protective Services form 


Virginia

The signature on the form below requires a notary.

Child Protective Services form 

  • The form below will be generated by the Criminal Background Check Unit upon receipt of your background check request.
  • An email will be sent to the provider and the applicant with instruction on how to complete and submit the form to our office.

Criminal History Record Information form 

Washington / Washington, D.C. / West Virginia / Wisconsin / Wyoming

Washington

The form below must be typed.

Child Protective Services form 


Washington, D.C.

This form must be typed. Five year address history and Photo ID are required.

Child Protective Services form 

A copy of a valid photo ID is required.

Criminal History Record Information form (Word docx)


West Virginia

Child Protective Services form


Wisconsin

This form requires a witness signature.

Child Protective Services form


Wyoming

Instructions will be emailed to the applicant.

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Contact Information

Criminal Background Check Unit
600 E. Boulevard Avenue, Department 325
Bismarck, ND 58505-0250
Phone: (701) 328-7575
Toll-Free: (800) 472-2622, 711 (TTY)
Fax: (701) 328-0358
Email: dhscfscbc@nd.gov