1

Required Package

The Pre-med Physician Shadowing Program at University of Wyoming requires the following background check to be performed.

Background Check:County Criminal Records (7 year history, all jurisdictions)
Nationwide Sexual Offender Registry
Healthcare Fraud & Abuse (OIG/GSA)
US Patriot Act / OFAC
Social Security Validation
Price:$42.50


I have read, understand and agree to the Viewpoint Screening Disclaimer.
Applicant Information
First Name*:  
Last Name*:
Middle Name:
Alias/Maiden Name 1:
Please Note: If you DO NOT have an alias name, leave this field blank. Only provide if you have used an alias within the last 7 years.
Alias/Maiden Name 2:
Please Note: If you DO NOT have an alias name, leave this field blank. Only provide if you have used an alias within the last 7 years.
Alias/Maiden Name 3:
Please Note: If you DO NOT have an alias name, leave this field blank. Only provide if you have used an alias within the last 7 years.
Social Security Number*:
-
-

Please Note: If you have not been issued a valid U.S. SSN then enter all zeros (000-00-0000) instead.
Date of Birth*:
/
/
(mm/dd/yyyy)
Gender*: Male        Female
Phone Number*: (111-111-1111)
E-Mail Address*:

Your email address will be your user name to log in. If you have placed a previous order, it is recommended to use the same email address to prevent separate logins. Separate logins will contain separate results / medical documents.
 
Type E-mail address.


Re-type E-mail address.
 
Current Residential Address:
Address*:
City*:
State or U.S. Territory*:

For an international address, select "International" and select the foreign Country name below.
Country*:
Zip Code*:
ZIP Code Look Up Tool
Please Note: If you have an international address that does not require a Zip Code, please fill in "00000".
      Payment in process. Please wait. Do not close this page until you receive confirmation.

Go Back to Main Page

web design and hosting by BlueTone Media