Background Check Form

To: Dean of Students,

I am applying to become an E-Scholar beginning spring 2013. Part of the process is to request that your office complete a background check on me and report it directly back to the McNeely Center by February 17th, 2012. Please send the form to the address at the bottom of the page.

I hereby give permission for the Office of the Dean of Students to provide the McNeely Center for Entrepreneurship any information about disciplinary situations that I have been involved with on the College of Saint Benedict and St. John’s University campuses.

Name__________________________ I.D. Number ___________________

Class (circle one):
First Year Sophomore

Signature____________________________ Date_______________

Summary of history and current status of any disciplinary action about the above student:

Donald McNeely Center for Entrepreneurship

Background Check Form

College of Saint Benedict

Saint John's University