Elective - Certiphi Request Form

To begin an Elective - Criminal Background Check, please supply the information below:

Students who are applying to an elective that requires a current criminal background check may use the SOM account with Certiphi. To begin the process please complete the form below. Please note that Certiphi places a $150.00 hold placed on your credit card. After the CBC is completed you will be charged based on the number of residences and names that have been used. Average Cost is about $40-$50.

The completed form will be entered into the Certiphi Screening System. You will receive an email from Certiphi informing you of how to proceed.

Fields with asterisks (*) are required.