Upon acceptance to Iowa Western’s Health Programs students are required to submit documentation of:
- Medicare Exclusion
- Criminal Background Check
- Dependent Adult or Child Abuse Registry Check
- Sex Offender Registry Check
All Checks are to be done in the student’s state of permanent residence and any/all states the student has resided, in the last seven years.
Programs Requiring Background Checks
- Practical Nursing
- Associate Degree; Nursing
- Dental Hygiene
- Dental Assisting
- Medical Assisting
- Emergency Medical Services
- Surgical Technology
- On the web page referred to below, type your name(s) in the spaces provided
- Include any names used in the past 7 years
- Click the search button and print the results
- Turn in the printed results to your nursing director
Sex Offender Registry Check
- Type in your name, please do the separate reports for each name you have used including maiden name if applicable.
- Click “Search”
- Print the screen that comes up and turn it into the Director of Nursing
Criminal & Adult/Child Abuse Background Checks
You will need to fill out both forms:
Download and print the request form and the Billing Form for mailing a check or for paying by credit card ($15).
- Ignore the account number and complete the rest of the information
- The top right side is your return address information so that the DCI can return the data to you directly
- The middlebox, “Request, “ is where you write your identification information about yourself
- The next box is the “results” section that the DCI will return to you stating whether or not you have a criminal history. This is proof that you will provide your school. Please note you need a separate Form A for each last name you have had. You do not need to sign the “Waiver” box because you are requesting this information of yourself.
- Each last name submitted requires a separate Request Form with payment for each.
- Ignore the Account Number blank and complete the rest of the page until the very bottom
- Put your last name on the first entry and ignore the remaining seven blanks
- A completed Billing Form is required when submitting record check requests to the DCI.
- Payment must be included unless a pre-paid account is established.
- All pre-paid accounts must submit an Account Number.
- Please check either Mail Back or Fax Back results; they will not do both.
- Send a stamped, self-addressed envelope and 2 pages (Form A and your Billing Form) to the DCI with your payment. Within approximately 2-4 weeks you will receive a response from the DCI. Turn in this report to the Director of Nursing
Abuse Registry Check
- Complete these two forms and mail them to the address provided on the Request for Dependent Adult Abuse Registry form.
- For the Request for Child Abuse Information form: Section I You-the student-are the requester.
- For the Request for Dependent Adult Abuse Registry information form: Under “position and basis for authorization” write “student”.
- On receipt of the response from the state agencies, turn the originals into the Director of Nursing.
Fill in your information on the form and mail in with $15 fee.
Adult/Child Abuse Registry Check
- Complete this form, and return to Wendy Ziegler, she will fax it to DHHS.
- There is no charge for this report
The form you need to complete to request both the background and abuse check is found on the Missouri State website.
- Print the Worker Registration form.
- Under Section A, check the box for “Voluntary Registrant”.
- Instructions for completing the rest of the form are included when you print it out.
On receipt of the response from the state agencies, turn the originals into the Director of Nursing.