ADE Director's Communication Memo Form

Memo Number : LIC-10-002

Date Created : 07/08/2009


Co-op Directors
Secondary Principals
Elementary Principals
Middle School Principals
High School Principals
other: Co-Op Coordinators

Type of Memo: Informational
Response Required: No
Section:   Human Resources/Licensure - Beverly A. Williams, Assistant Commissioner
Child Maltreatment Central Registry Check

Regulatory Authority:

Contact Person:
Ron Tolson

Phone Number:


This Commissioner’s Memo is in response to questions that have arisen regarding the application form for the child maltreatment central registry check that was attached to Commissioner’s Memo LIC-09-037.

The second paragraph of the application form says that the fee applies to everyone except potential employees, non-profit organizations and indigent persons. Potential employee’s is referring to potential employees of the DHS Department of Children and Family Services and has been corrected by DHS to read that way on the application. Schools are not considered non-profit organizations for this purpose. Whether or not a teacher or classified employee is indigent will have to be taken up with DHS.

Replace the previous application form with the one attached with this memo.

Information regarding who the results of the background check will be sent to has been filled in with the correct information.

Under applicant’s name, list last name, first name and middle name/initial.

Under age and date of birth, list month, day, year (--/--/----).

Under past address, list the address that was prior to the present address.

Social Security Number is the number for the applicant.

Under full name and date of birth of children, please give this information for all children regardless of age that have lived in the household. Write in the date of birth as listed above. If the number of children to be listed exceeds space allowed on the application, carry additional names over on a blank sheet of paper and attach to the application.

Please distinguish whether the application is for a licensed educator or non-licensed employee.

This is the only form to be used when applying for the child maltreatment central registry check for either licensed educators or non-licensed employees.

Please address any questions regarding child maltreatment central registry checks to Ron Tolson at 501-683-3126, or by e-mail at


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