Pennsylvania Access To Criminal History - Record Check Certification Page | of 1 West Middlesex school required Shannon to renew her clearances for observation. She wanted us to have a copy. Pennsylvania State Police 1800 Eimerton Avenue arisburg, Pennsylvania 17110 Response for Criminal Record Check ‘SHANNON KURITZ 1119 GREENFIELD RD ‘TELEPHONE (724) 813-5259 HERMITAGE PA 16148 ‘TO WHOM IT MAY CONCERN: ‘THE PENNSYLVANIA STATE POLICE DOES HEREBY CERTIFY THAT: Kuritz, Shannon 06/05/1995 2HX-7H- 7668, F White Date of Request: 10/23/2015 08:51 AM Purpose of Request: Other n Name and/or Alias (1) (2) @) (4) '*** HAS NO CRIMINAL RECORD IN PENNSYLVANIA BASED ON A CHECK BASED ON THE ABOVE IDENTIFIERS - REFER TO CONTROL #R15098928 *** ‘THE RESPONSE IS BASED ON A COMPARISON OF DATA PROVIDED BY THE REQUESTER AGAINST INFORMATION CONTAINED IN THE FILES OF THE PENNSYLVANIA STATE POLICE CENTRAL REPOSITORY ONLY. PLEASE CONFIRM IDENTIFIERS PROVIDED. POSITIVE IDENTIFICATION CANNOT BE MADE WITHOUT FINGERPRINTS THE PENNSYLVANIA STATE POLICE RESPONSE DOES NOT PRECLUDE THE EXISTENCE OF CRIMINAL RECORDS, WHICH MIGHT BE CONTAINED IN THE REPOSITORIES OF OTHER LOCAL, STATE, OR FEDERAL CRIMINAL JUSTICE AGENCIES. ‘THE INFORMATION ON THIS CERTIFICATION FORM CAN BE VALIDATED BY ACCESSING THE PENNSYLVANIA ACCESS TO CRIMINAL HISTORY (PATCH) RECORD CHECK STATUS SCREEN (https://epatch.state.pa.us/RCStatusSearch.jsp) AND SUBMITTING A STATUS CHECK REQUEST THAT CONTAINS THE FOLLOWING - SUBJECT'S NAME (EXACTLY AS INITIALLY ENTERED), CONTROL NUMBER AND DATE OF REQUEST. PATCH WILL FIND AND DISPLAY THE CORRESPONDING RECORD CHECK REQUEST. DETAILS ON THE REQUEST CAN BE VIEWED BY CLICKING ON THE CONTROL NUMBER. YOU WILL BE ABLE TO VERIFY IF THIS REQUEST WAS SENT OUT AS A NO RECORD OR RECORD RESPONSE BY THE PENNSYLVANIA STATE POLICE. QUESTIONS CONCERNING THIS CRIMINAL RECORD CHECK SHOULD BE DIRECTED TO THE PATCH HELP LINE TOLL FREE AT 1-888-QUERY-PA (1-888-783-7972). Certified by: ! hu, DISSEMINATED BY: SYSTEM 10/23/2015 08:52 AM Lieutenant Kevin 3. Deskiewicz, Director Criminal Records and Identification Division Pennsylvania State Police hitps://epatch state.pa.us/invoiceAndCentForm.do?submit=certificate 10/23/2015016390 pennsylvania DEPARTMENT OF HUMAN SERVICES SHANNON KURITZ 1119 GREENFIELD RD HERMITAGE, PA 16148 PENNSYLVANIA CHILD ABUSE HISTORY CLEARANCE CERTIFICATE ID: 865VK63NI6 VERIFICATION DATE: 10/26/2015 ‘SOCIAL SECURITY #: XXX-XX-NONE DATE OF BIRTH: 6/5/1995 The ebove named person has applied for a Pennsylvania Child Abuse History Clearance pursuant to Chapter 63 of 23 Pa. Consolidated Statutes Annotated relating to the Child Protective Services Law. NO RECORD EXISTS in the Pennsylvania Department of Human Services’ statewide Central Registry listing the applicant as a perpetrator of an Indicated or Founded report of child abuse or an Indicated or Founded report for school employees. Applicants are required to show the Administrator the results of their Child. Abuse History Clearance. Administrators are required to keep a copy of this Child Abuse History Clearance on file. Any person altering the contents of this document may be subject to civil, criminal or administrative action. ISSUED BY Commonwealth of Pennsylvania Department of Human Services CHILDLINE AND ABUSE REGISTRY ChildLine Verification Unit P.O, Box 8170 Harrisburg, PA 17105-8170 1-877-371-5422 cv930- 600 ee on150s00s90010101sano1e PAcegisvaion receipt Shannon Kuri PA registration receipt noreply@mmm.com Fri 3/4/2016 11:30 AM ToShannon Kuritz ; Dear Cogent Customer, Thank you for Registering. There is your register information: Registration Date: 03/04/2016 Registration ID: PAE1633D56586337 Last Name: KURITZ First Name: SHANNON Transaction Type: COLLEGES/UNIVERSITIES Payment Type: Credit Card Transaction Fee: $27.00 Transaction Date: 03/04/2016 Transaction Status: Registered Fingerprint Date: Fingerprint Site: Results Received Date: TCN: tp otockoca366 confovarhiouradel-ResadMessogellemBleniD= AAMIAGNIM2C5YWRnLTgSMzVINDYING INY)NILTODIAZTERZWEMABGAAA.. 14Student Health Services Edinboro University Of Pennsylvania 300 Scotland Road, Edinboro, PA 16444 814.732.2743" Fax: 814-732-2666 ‘Tebereulin mantoux test; ‘This testi an accurate, intradermal screening method used for the detection of tuberculin activity. resautions; 1. Is there a history of tuberculosis in your family. 2. Have you been recently exposed to Tuberculosis? 3. Have you ever had a postive Tuberculin Test, 4. Have you been treated with INH following a positive testin?... ‘5. Doyou have a sensitivity to either? alcoho acetone.. 6. Females: Is there a possibility that you are pregnant? ., First day of last menstrual period (LMP) OC + 7. Tunderstand that I must make a retum eppointment to have the read between 48-72 hours after itis placed, YESY.NO__ have read the information on this form sbout the Tuberculin Mantoux Test. I request thatthe Tuberculin Mantoux Test be administered to me. If you are under 18 years of age, this test will not be administered without parental permission, Postive reactions ulght require further dlagnoslc procedures. Patient Information (Please Print) Name Kuy i YL INGA phone _ZIY- $13 -S ASA ‘Last Name First Name wr QOO44 7 : rel nite 0S) 1¢¢5° Local Adress pea De A nem sac OA bivs ‘Street City ‘State Zip Code {authorize the Student Heath Services to release this information to myself, another healthcare facility, pace ‘of employment or academic departments, upon my request. sire DO Jnawrnane Muni pae_}/5/20) 4 oucciven tS py Nidedt en) site(RJeoream Povres Es IY my FOG MN Mrean_ Gorm (real tive) Manure, Senof Postar Lot _C¥C3aNA_ Exp. dete_Il) OS 1/6Certificate of Completion SESSA RETEST IE TON SIAEN SD : Certificate of Completion _ we Recognizing and Reporting Child Abuse: y Mandated and Permissive Reporting in Pennsylvania @ esi ic ar a's Wag naive ‘ 2rd can bos } Presenter: & University of Pittsburgh Schoo! of Social Work, PA Child Welfare Resource Center Presented to: § Kuritz, Shannon & X 2/29/2016 Y? Provider Number G ‘CACE000004 a CE Course Number ty Pewc00d0: hups:/Awww.reportabusepa,pitt.cdw/eourses/1/rrca-205 I/content/_8122_I/pageS6908.html Page 1 of 1 2/29/20167 rv elofl wd: Membership Receipt / Coverage Confirmation - Shannon Kuritz Page | of Fwd: Membership Receipt / Coverage Confirmation Keystone Teachers Association ced 372/20164 41 Shannon Kutitz > © Original message -- > Subject Membership Receipt / Coverage Contirmation > From: Keystone Teachers Association > To: > Date: Tuesday, 02/02/2016 10:18 AM > Shannon Kuritz » INS Greenticla Road ereitage PA 19°45, > Dear Shannon: > Thank you for your membership to the Keystone Teachers Association > Please use this letter as proof of receipt for your student dues > payment in the amount of $30.00, > Your membership includes KEYTA's $2 mullion professional habilty > insurance coverage, as well as many other benefits and services. Your > membership began on February 1, 2016 and wall be valid through > December 31. 2016, A membership packet will be mailed to you shorty, > Ifyou have any questions, please fee! free to contact us at our » tollfree number at 877-33-KEYTA or nfcwkeyta org > We look forward to supporting you your teaching orofession > Sincerely. > MEMBERSHIP DEPARTMENT > Keystone Teachers Association https://outlook.office.com/owa/ 3/2/2016