CONFIDENTIAL CRIMINAL HISTORY RECORD INFORMATION The Bryan Independent School District is authorized by state law and BISD Board Policy to maintain criminal history records of all applicants serving as a volunteer. (Government Code 2109.004(b), GKG (Legal). All information requested below is required to obtain records for the Texas Department of Public Safety and will be kept confidential. This form and a signed and dated “DPS Computerized Criminal History (CCH) Verification” form are required for processing. Please print legibly. NAME_____________________________________________________________________________________________________ Last First Middle Bryan ISD student’s Name(Parent Volunteers Only)_________________________________________________ Other Names Known By (maiden, aliases, etc.)_______________________________________________________ DATE OF BIRTH___________/______/_____________________________ MM/DD/YYYY Phone Number_________________________________ E-Mail address_______________________________________ Please check the appropriate box VIPS/PTO Texas A&M/Blinn Instructor’s Name_________________________________ Be The One Volunteer Sam Houston University Church/Community Volunteer Substitute/Auxiliary Employee/Paid Tutor Campus/Organization_______________________________________________________________________________ I understand that the information I am providing will be used solely for the purpose of obtaining criminal history record information. All reviews, if needed, will be processed by the Bryan ISD Human Resources Office and are kept confidential. SIGNATURE________________________________________________________________ Date________________________________ Revised 10/2014 Volunteers: 1307 Memorial Dr., Room 200 Bryan, TX 77803 979-209-2880 Employees: 101 North Texas Ave. Bryan, TX 77803 979-209-1000