PROVIDER FORMS:

Click here to download Agency Referral Form (updated 3/2015)

Instructions for submitting completed forms:

  • Mail to Marley’s Mission, 2150 Port Royal Road, Clarks Summit, PA, 18411 (Note: Mark envelope CONFIDENTIAL.)
  • NEW NUMBER! Fax: 570-587-4676 (Note: This is a confidential fax system.)

VOLUNTEER FORMS:

Volunteer General Application Form

Internship / Practicum / Service Learning Application Form

Return forms to:

Mail: Marley’s Mission, 2150 Port Royal Road, Clarks Summit, PA, 18411

Fax: 570-587-4676

Email: helpnow@marleysmission.co

Volunteer Applications will be kept on file.

BACKGROUND CLEARANCE FORMS AND INSTRUCTIONS:

(Required for all Volunteers/Trauma Team Members/Interns/Staff)

PA Child Abuse Clearance Form

  • Must be mailed to the ChildLine & Abuse Registry address indicated on form.   Results will be mailed to applicant.   Upon receipt of results, applicant must provide copy to Marley’s Mission to be kept on file.
  • Click here for or step-by-step instructions.

FBI Background Check – Link to Register with Cogent  Systems

  • Must pre-register online with Cogent Systems and then go to authorized fingerprint location; results will be mailed to applicant.  Upon receipt of results, applicant must provide copy to Marley’s Mission to be kept on file.
  • Click here for step-by-step instructions.

 

INTERNAL USE ONLY:

MASTER FORMS (Password Protected)