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 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 ~$55 but can vary.

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.

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