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)