Please use this form as notification to the Office Human Resources of:
Individuals providing services to the university without compensation, or...
Individuals providing a program, activity or service to the university on university property compensated by a university affiliate, not through IUP Payroll Services
Background clearances are required for those who services involve the care, supervision, guidance, or control of minors, as determined by the Office Human Resources. The background clearances process will be initiated based on responses to this form for those whose clearances are tracked and stored by the Office of Human Resources.
Title of Position
Maiden or Previous Name
Address Line 1
Address Line 2 (Optional)
Primary Contact Phone Number
Phone Number Type
Personal or Other Email Address
*Indicates clearances that are initiated and recorded through the IUP Office of Human Resources.
Please provide a brief description of the services being performed by this individual.(If you selected "Other" for the group, above, please provide the department or office and other details in this section.)
Name of Supervisor or Responsible Party
Email is the primary method of communication for all employees, contractors, and volunteers. An IUP email address is provided with access to the IUP network. It is the user’s responsibility to activate their email and ensure storage limits are not exceeded.
If yes, please describe how access to the IUP network will be used in providing services to the university.