Safe Environment Reference Form

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Email REQUIRED Please fill out this field. Please enter an email address.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

I have completed STEP 1: Create an account with the Diocese of Raleigh at https://dioceseofraleigh.safeenvironment.org/ REQUIRED I agree Please fill out this field.

I have completed STEP 2: Submitted a background check via the Diocesan Safe Environment Database REQUIRED I agree Please fill out this field.

I have completed STEP 3: I have registered for a(n) REQUIRED Please fill out this field.

I understand that I must attend my training to become certified.

I Agree Please select this field.

Please select the location of your ministry activities (check all that apply) REQUIRED St. Thomas More School St. Thomas More Parish (Youth Ministry or other ministry) Other Diocese of Raleigh Locations Please fill out this field.

Reference Information

List at least three personal references that could attest to your character and leadership abilities. Please inform them that you have named them as a reference and that they should anticipate being contacted via email. Please do not list any family members as references.

If you have any questions, please contact Celeen Lawrence at [email protected] or call 919.942.6203. Hours: Tues, Wed, Thurs 9:30 - 1:30

REFERENCE ONE

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.
Email REQUIRED Please fill out this field. Please enter an email address.
Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.

REFERENCE TWO

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.
Email REQUIRED Please fill out this field. Please enter an email address.
Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.

REFERENCE THREE

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.
Email REQUIRED Please fill out this field. Please enter an email address.
Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.

OPTIONAL: ADDITIONAL REFERENCE

First Name Please enter valid data.

Last Name Please enter valid data.
Email Please enter an email address.
Phone Number Maximum 20 characters Please enter a phone number.

OPTIONAL: ADDITIONAL REFERENCE

First Name Please enter valid data.

Last Name Please enter valid data.
Email Please enter an email address.
Phone Number Maximum 20 characters Please enter a phone number.

I certify that my references are not family members REQUIRED I agree Please fill out this field.

I have notified my references that they will be contacted via email REQUIRED I agree Please fill out this field.

I understand that my certification is not complete without a response from three of my references REQUIRED I agree Please fill out this field.

I understand that volunteering with youth is a privilege, not a right, and that ministry or school leaders can deny or revoke volunteer privileges even with SET Certification. REQUIRED I agree Please fill out this field.

Please type your full legal name to electronically sign this form and click submit. REQUIRED Please fill out this field.