Department of Secondary Education
Criminal Background Check Requirement
for Early Field-based Experiences
As a result of the Jessica Lunsford Act (1012.465 F.S.), any students participating in an early field experience (that
involves direct contact with students or exceeds 15 hours) or final internship in a public school setting is required to
undergo a criminal background check.
Foreign Language Education
Language Arts Education
Mathematics Education
Science Education
Social Science Education
FLE 4370 / FLE 5946
LAE 4530/ LAE 6325
MAE 6945
SCE 6938
SSE 4335 / SSE 5946
To be admitted to College of Education, students had to submit a Disclosure of Conviction form. This form provided
information that supported admission to the College. To meet course and degree requirements for programs in the
Department of Secondary Education, you must undergo a Criminal Background check because students are required to
interact with public school students. To be permitted to work with students in a public school settings, the school
district has the legal right to review your records and they decide whether you can complete pre-internships or
internships in their schools. School districts have the legal right to obtain information regarding sealed, expunged,
and/or juvenile records. Please note that the Criminal Background Check procedures used by each school district vary.
Students who are not cleared by a School District cannot continue in the COEDU and must change majors.
Therefore, it is important for you to assess your ability to meet this requirement. If you have ever been arrested for,
pleaded nolo contendere to, or been convicted of a first-degree misdemeanor or felony, we encourage you to verify
your ability to work with public school students prior to enrolling in coursework. This will provide time to change your
major if there is anything in your background that would prevent you from completing course and/or degree
requirements.
If you are sure that you have never been arrested for, pleaded nolo contendere to, or been convicted of a first-degree
misdemeanor or felony, then you can complete the process
 prior to the semester in which you will take a course with a field experience component,
 at the beginning of the semester in which you will take a course with a field experience component, or
 as directed by faculty members in your program area.
Please keep the following information in mind as you engage in the process:
1. It takes time for school districts to process the information and indicate whether you are permitted access to
schools and students.
2. School will not allow you access to students until formal approval is documented.
School District Procedures:
Hillsborough: Follow the procedures outlined in the School District of Hillsborough County Criminal
Background Check Procedures document provided by the Department of Secondary Education. The
approval period is for one year.
It is important to note that field experience placement may depend on course and internship assignments.
For additional Information about the Criminal Background Check requirement, please contact Kate Boney at
Boney@usf.edu
(813) 974-4947
_________________________________________________________________________________________________________
DEPARTMENT OF SECONDARY EDUCATIONCOLLEGE OF EDUCATIONUNIVERSITY OF SOUTH FLORIDA
4202 E. Fowler Ave, EDU105Tampa, FL 33620-5650(813) 974-3533Fax (813) 974-3837http://www.coedu.usf.edu/main
School District of Hillsborough County (SDHC)
Criminal Background Check Procedures
Step 1. Complete the USF Student Information Form and SDHC Criminal Record Information Form and turn it in to the locked drop
box in the Secondary Education Office (EDU 302) between the hours of 8 and 5 Monday through Friday. The deadline for turning in
this form is no later than:
 July 1st for fall practicum courses, and
 November 1st for spring practicum courses.
Note: It is very important that you be entirely honest on this form. School districts have the right to obtain information regarding
sealed, expunged, and/or juvenile records. The information you provide will be kept confidential and will only be shared with Kate
Boney, the Field Experience Coordinator, and the School District of Hillsborough County.
Step 2. The SDHC Criminal Record Information Form will be forwarded to SDHC for their Preliminary Clearance.
Following SDHC review, you will be informed by Kate Boney as to whether or not you have passed this preliminary background
check. Individuals who do not pass the preliminary check may not be able to complete course and/or degree requirements in the
Department of Secondary Education. These students will be encouraged to pursue a different major. Those who do pass the
preliminary check (i.e., “cleared students”) will proceed to Step 3.
Step 3. The cleared student must go to the SECED office (EDU 302) to pick up the following yellow forms from Candice Pietri:
 SDHC Employee-Preinterns Information Form.
 SDHC Finger Printing Verification Form - Preinterns
Note: Only cleared students will be permitted to pick up these forms.
You will take these two forms to SDHC where your fingerprints will be taken and sent to the Federal Bureau of Investigation.
Step 4. If cleared, go to the SDHC Instructional Services Center to be fingerprinted (see forms for the address). Please note the
following:
 There is a processing fee for fingerprinting and must be paid by one options stipulated on the Fingerprinting Verification
Form. This must be completed prior to appearing for fingerprinting.
 When you enter the parking lot to the Instructional Services Center, inform the parking attendant on duty that you are at
the building to be fingerprint for your USF internship.
 Be sure to bring a photo ID and the two completed yellow forms (see Step #3).
 After you have been fingerprinted, you will be given a copy of the stamped and initialed SDHC Finger Printing Verification
Form. SDHC reserves the right to rescind this preliminary clearance should the check with the FBI or negative information
become available. Under such circumstances, the student must drop or withdraw from the course and/or petition for a late
withdrawal.
 The clearance is good for one year from the date stamped on the SDHC Finger Printing Verification Form. It is prudent to
renew the clearance prior to the expiration date if you anticipate completing field experiences with the SDHC. There is a
nominal fee to renew. To renew, contact the district.
Step 5. Upload a scanned copy of your stamped SDHC Finger Printing Verification Form to your Chalk & Wire eportfolio under
"administrative elements," within the subsection entitled "Early Field Experiences and Criminal Background Check." Select Kate
Boney as your assessor. Failure to do so could result in your being dropped from a Department of Secondary Education course or
program. Course instructors may also request a copy of this form, either digital or hard copy, before they will place you in a school.
Step 6. You must turn in your original verification form to Dianne Wood in Student Academic Services, EDU 105. Your form will be
held there to be added to your final internship application.
Any questions you have about these procedures should be addressed to:
Kate Boney, Field Experience Coordinator
Boney@usf.edu
(813) 974-4947
Department of Secondary Education
Student Information Form
For Practicum / Early Field Experience
DIRECTION: Please affix this form to the SDHC Criminal Record Information
Form and submit to Department of Secondary Education.
Scan/Email:
boney@usf.edu
Drop Off Location:
EDU302: Candice Pietri
Mail Location:
Attention Kate Boney, Field Experience Coordinator
at the address provided below.
Undergraduate
Graduate Student
Student Name
USF Student ID
Please indicate your affiliation with the Department of Secondary Education. Be sure to only
mark only one option.
English Education Major
Foreign Language Education Major
Mathematics education
Science Education Major
Social Science Education Major
Non-secondary Education Major (Enrolled in ESOL 1)
COURSE and SEMESTER for which you need clearance (i.e. SSE 4335, Spring 2013):
__________________________________________________________________
USF Email Address
Alternative Email Address
(optional)
Home Phone Number
Cell Phone Number
(optional)
DEPARTMENT OF SECONDARY EDUCATIONCOLLEGE OF EDUCATIONUNIVERSITY OF SOUTH FLORIDA
4202 E. Fowler Ave, EDU105Tampa, FL 33620-5650(813) 974-3533Fax (813) 974-3837http://www.coedu.usf.edu/main
PLEASE PRINT
Name ___________________________________________________________________ Social Security Number _________________________________
(Last)
(First)
(Middle)
CRIMINAL RECORD INFORMATION - ALL APPLICANTS PLEASE READ VERY CAREFULLY.
ATTENTION:
Under provisions in Florida Statutes 943.0585 and 943.059, the entire arrest record is revealed to school districts by
the Florida Department of Law Enforcement and the FBI when fingerprints are supplied, including "sealed records"
and "expunged records." Therefore, you are required to reveal such information on this application.
NOTICE TO APPLICANTS:
You must provide all information requested, regardless of whether your criminal record has been sealed in any part.
Florida law allows the School Board access to sealed and/or all other criminal records. Information disclosed pursuant
to this section will be evaluated on an individualized basis, taking into account the nature of the offense and underlying
conduct, the relevance of the offense to the employment position(s) for which you are applying, the proximity in time
of the occurrence of the offense in relation to this application, and other relevant factors. However, your failure to
disclose any requested information will, in the absence of extraordinary, mitigating circumstances, result in the
rejection of your application or, if the non-disclosure is discovered after your hire, the termination of your
employment.
Have you ever been arrested or charged for a criminal offense other than a minor traffic
violation? (DUI is NOT considered a minor traffic violation.)
○ Yes
○ No
Is there any criminal charge now pending against you other than a minor traffic violation?
(DUI is NOT considered a minor traffic violation.)
○ Yes
○ No
Are you currently on probation or currently under any imposed requirements for charges
other than a minor traffic violation? (DUI is NOT considered a minor traffic violation.)
○ Yes
○ No
If YES to any of the above, give details below AND refer to page two of this document for further requirements.
Date
Location of
Charge(s)
Nature of Charge(s)
Disposition of Charge(s)
Is the record
sealed?
Is the
record
expunged?
I certify that the answers given by me to the foregoing questions and statements are true and correct without any falsifications,
omissions, or misleading statements of any kind whatsoever. I agree that Hillsborough County Public Schools shall not be held liable
in any respect if I am not employed or if my employment is terminated because of false or misleading statements or answers or
omission made by me in this application.
---------------------------------------------------------------------------------------------------------- -----------------------------------------Signature
Date
PLEASE NOTE: The application of any person with a criminal history requires review and approval to determine
eligibility for employment. If you have such a criminal history, your application will be held in a pending file until
the review process is complete.
For each criminal charge listed on page one of this document, provide a narrative account of the circumstances
leading to the charge. (You may attach additional pages.) Include in this statement,
• the level of the charge (felony or misdemeanor),
• the resolution of the charge, and
• the conditions imposed upon you as a result of the charge.
Depending on the nature and outcome of the charges described below, you also may be requested to secure and
provide a copy of the arresting agency's report, verification of the court's ruling, and documentation of successful
completion of imposed conditions.
***Notice***
HCPS collects your Social Security number for the following purposes:
Identification and verification, employment qualification, tax reporting, benefits and retirement processing, unemployment compensation, and state
reporting to the Department of Education. Social Security numbers are also used as a unique numeric identification within some of our systems and
may be used for search purposes.
***Noticia***
Las Escuelas Publicas del Condado de Hillsborough requieren su numero de Seguro Social para los siguientes propósitos:
Identificación y verificación, requisitos para ser empleado, informes fiscales, prestaciones y el procesamiento de jubilación, indemnizaciones para
desempleo, y los informes estatales al Departamento de Educación. Los números de seguro social también se utilizan como una identificación
numérica única dentro de algunos de nuestros sistemas y pueden ser utilizados para buscar información.
Criminal Record Information Form -- Page 2 of 2
Hillsborough County Public Schools
Rev. 04/09