VERIFICATION OF NO CRIMINAL RECORD
PUPIL PERSONNEL SERVICES CREDENTIAL
WITH ADVANCED SPECIALIZATION IN SCHOOL PSYCHOLOGY
I certify that I have never been convicted of a crime other than a minor traffic violation.
Applicant signature -------------
Date
Applicant printed name ------------------
This form should be downloaded, filled out and sent back with your online department
application. You may also either fax (559-278-7910) or mail the form directly to the
Department of Psychology, 2576 E. San Ramon Ave., M/S ST11, Fresno, CA 93740-8039
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