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Vulnerable Populations Agency/Educational Institution Application

Please complete the fields below to apply for status as a Vulnerable Population Agency or Educational Institution. The information you provide will be reviewed by the Vermont Criminal Information Center (VCIC). Once reviewed, you will be contacted by VCIC as to whether your application has been accepted, which normally takes 5 to 7 business days. Once accepted, you will be able to retrieve criminal conviction records using this service at no cost.

A qualified entity is defined as an individual, business, governmental agency, or organization, whether public, private, for-profit, not-for-profit, or voluntary whose employees, contractors, or volunteers provide care or care placement services for vulnerable populations. Providing care for vulnerable populations means the provision of care, treatment, education, training, instruction, or supervision to children, the elderly, or individuals with disabilities. The entity's PRIMARY function must be to provide care to vulnerable populations.

Educational Institutions are members of public or independent schools in Vermont which provide elementary and/or secondary education. .Public school. means an elementary school for which the governing board is publically elected. "Independent school" means a school other than a public school, which provides a program of elementary or secondary education, or both and undergoes the school quality standards process and meets the requirements of T. 16 V.S.A. sec. 165 (b).

* Required Fields

Agency/Business/Organization Information

Name of Entity/Organization: *
Organization Type: *
Address: *
Address (cont.):
City: *
State/Province: *
Postal Code: * -
Country: *

Contact Person

First Name: *
Last Name: *
Title:
Telephone: * () - extension:
Fax: () -
Email Address: *

Reason For Application

Please briefly provide the reason why you believe you qualify as a Vulnerable Population entity or an Educational Institution: *
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