ACT 151 PA CHILD ABUSE HISTORY CLEARANCE - dasd-sharepoint dasd 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin with Section I by entering your full legal name, current address, and personal information clearly. Avoid using initials.
3. In the Previous Names section, list all names used since 1975, including maiden names and aliases.
4. Select one purpose for clearance by checking the appropriate box. Ensure only one box is checked to avoid processing delays.
5. Fill in all previous addresses since 1975. If necessary, attach additional pages for completeness.
6. List all household members who have lived with you since 1975, providing their relationship and age.
7. Sign and date the application before submission to ensure it is processed without issues.
8. Prepare a business-sized envelope for mailing your completed application along with a $10 money order payable to the Department of Public Welfare.

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