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Aquinas College School of Education
ICHAT Permission Form
The Aquinas College School of Education has my permission to search ICHAT (Internet Criminal History Access Tool) for any felony or misdemeanor convictions on my record. I understand that the information provided in this release form and received from the ICHAT report is confidential. I understand that I may be dismissed from the School of Education if I falsify any information regarding my background check during my time in the teacher certific a t i o n p r o g r a m a t A q u i n a s C o l l e g e .
S i g n a t u r e : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ D a t e : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
T h e f o l l o w i n g i n f o r m a t i o n i s r e q u i r e d i n o r d e r t o c o n d u c t a n I C H A T s e a r c h :
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O t h e r L a s t N a m e : _ _ F O R M T E X T _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
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