Safe Environment Volunteer Form

The Diocese of Dallas has mandated that everyone who handles money, volunteers in the CPLC office, works with children, youth, vulnerable adults and/or developmentally disabled attend Safe Environment training annually following an initial Family of Faith Training, screening and background check. Please provide the following information showing your current Safe Environment status..

First Name *
Last Name *
Date of Birth *
Driver’s License # & State*
Home Address*
City*
Zip Code *
Phone *
E-mail Address*
Parish or Church*
Identify the CPLC ministry or event you are volunteering for:*	Healing after Abortion Bishop's Dinner Volunteer Bishop's Dinner Youth Chaperone Convert-to-Life (Sidewalk Counseling) Project Gabriel Hispanic Pastoral Ministry Speakers Bureau Youth for Life (Chaperone) Other
If other, please specify:
Are you currently Safe Environment cleared?*
If you answered 'yes', please provide the name of parish/school/entity where your Safe Environment clearance is recorded. If you answered 'No,' please contact after submiting this form.
Full name of entity with record of Safe Environment clearance
City and State of entity with record of Safe Environment clearance
Diocese of entity with record of Safe Environment clearance

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