COVID-19 Campus Updates and Resources: Wearing a face mask and practicing physical distancing are required. Visit our Stay Healthy, Stay Safe. Navigating COVID-19 Together website for more information.

Spring 2021 Course List: This course list identifies face-to-face classes that will be delivered via Zoom at their scheduled days and times through March 19. All other courses will run as scheduled at their designated days, times, and locations.

Extended hours: Many offices are open 8:00am–6:00pm weekdays through January 22. Offices with extended hours include Student Services, Business Office, Financial Aid, and Admissions.

Background Check Disclosure and Release Form

As part of the application process for acceptance into a Health and Human Services program at Hawkeye Community College, its agents may conduct an investigation of your personal information.

This investigation may include, but is not limited to:

  • Criminal history records from private, city, state, and federal sources
  • Social security number and/or fingerprint trace
  • Residence history
  • Sex offender and child/dependent adult abuse registries

These records may be used to determine your eligibility and acceptance into Hawkeye's healthcare, police science, and early childhood programs; plus clinical agency and practicum activities.

Background Check Release Form

All fields marked with * are required.

Example: PNN-100-101
Example: 4/1/2020  
Your social security number is needed to process the background check.
(yyyy)




Background Check Disclosure

By submitting this release form, I agree to the following terms:

  • I understand that Hawkeye Community College and its agents may conduct an investigation of my personal information as part of the application process for acceptance into a Health and Human Services program at Hawkeye Community College.

  • I understand that this investigation may include, but is not limited to:

    • Criminal history records from private, city, state, and federal sources
    • Social security number and/or fingerprint trace
    • Residence history
    • Sex offender and child/dependent adult abuse registries.
  • I understand these records may be used to determine my eligibility and acceptance into Hawkeye's healthcare, police science, and early childhood programs; plus clinical agency and practicum activities.

  • I authorize without reservation the full release of these records to Hawkeye Community College and/or its agents contacted to obtain information.

  • I understand that there is a $15, non-refundable, student fee to process the background check.

  • I release and discharge Hawkeye Community College and all of its agents and associates any expenses, losses, damages, liabilities, or any other charges or complaints for the investigative process.

  • I authorize the full release of the information described above, without reservation, throughout the duration of my enrollment at Hawkeye Community College.

  • I certify that, to the best of my knowledge, all information on this release form is correct.

  • I understand any false statements will be considered just cause for dismissal.

  • I understand that I can request that Hawkeye Community College supply me with a copy of my report as pursuant to my rights covered under the Fair Credit Reporting Act.

You will see a confirmation screen once your release form has been submitted. If you do not see a confirmation screen, scroll up and complete missing required information.

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