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HomeCASA Background Check Release Form

CASA Background Check Release Form

Please fill out and Submit the CASA of Grayson County Background Check Form.

Name*
First Middle Last
Other names or spellings used (married, maiden, alias, etc) First, Middle, Last
Address*
Street Address Address Line 2 City State ZIP Code
Address continued - County*
Primary Phone Number*
Alternative Phone
Date Of Birth*
Gender*
- Male
- Female
Social Security Number*
Race*
- Asian
- Black
- White
- Native Amercian
- National Hawaii/Pacific Islander
- Unable to Determine (or, non of the above)
Ethnicity*
- Hispanic
- Not Hispanic
- Unable to Determine
List other places you have resided (For a minimum of the past 5 years)*
Email*
Consent for CASA of Grayson County Inc. Background Check*
I grant permission to the CASA of Grayson County Inc. to perform background checks as required by National and Texas CASA Standard 5(B) on my behalf.
I am the person listed above and the information I provided is true and Correct. I grant permission to the CASA of Grayson County Inc. to perform background checks as required by National and Texas CASA Standard 5(B) on my behalf.

I understand and acknowledge that CASA of Grayson County Inc. staff will not disclose this information to other individuals only to the extent that is specifically authorized.

CASA of Grayson County
101 E Jones St
Sherman, TX 75090
Phone: 903-813-5400
FAX: 903-870-0880