Volunteer Clearance Fee Reimbursement Form

Derry Area School District Volunteer eligibility for reimbursement of clearance fees


•    A volunteer will need to volunteer for a minimum of 20 hours collectively within a 5 year
      period while their clearances are current.
•    Volunteer must provide the following to be eligible for DASD reimbursement of clearance fees:
          o Completed “DASD Volunteer Activity Clearance Fees Reimbursement Form” which includes a  minimum of 20 hours documented activities/events and signed off by a teacher OR the administrator
          o Receipt of payment for the Act 114 FBI clearance on file
          o Receipt of payment for the Act 34 PA Criminal History clearance on file
          o Receipt of payment for the Act 151 PA Child Abuse clearance on file

Submit completed DASD Volunteer Activity Clearance Fees Reimbursement Form; Act 114 FBI receipt;
Act 34 PA Criminal History Record Check receipt; and Act 151 PA Child Abuse receipt to:

Brenda Bitz
Confidential Executive Secretary/
PAL Volunteer Coordinator
Derry Area School District
982 N. Chestnut Street Ext.
Derry, PA 15627

* A list of all volunteers and their clearances will be maintained in the Superintendent's office.  Also, copies of all eligible voulnteer certifates will be located at each school office.