As a part of our volunteer process, you must successfully complete a background check. In order to make this process quick and easy, Delta Sigma Theta Sorority, Inc. requires that you complete the following request. By providing this information electronically it can be safely and securely transmitted to our background check vendor instantly. This enhanced process can remove days of waiting from the overall process. Please remember to do the following:

1)Complete all fields.
2)Use your legal name and information. If you choose to have any maiden or previous names searched in the additional names section, you are responsible for any additional fees associated with this search.
3)Review your answers for accuracy and spelling.
4)In order to receive a copy of your background report, you must check the box that says “Want a free copy of your report?”
5)If you have any questions or special circumstances you should contact the Regional Risk Management Coordinator at Do not contact the background screening vendor directly. All inquiries should go through the Regional Risk Management Coordinator(s).

Please note: If your background screening clears automatically, you will receive a copy of your report via email (only if you checked the box to receive a copy). If you do not receive a copy automatically, your background screening may be in an "in progress" status, which only means that your background screening is being reviewed. Once it is reviewed, a determination will be made to clear or not clear based on the Sorority's disqualification policy found in the Sorority's Risk Management manual. Please do not contact the vendor, Palmetto Security Services, directly. Direct all inquiries to your Regional Risk Management Coordinator.

Thank You,

Jacqueline A. Dillard
Central Regional Director
Last Name
First Name
Middle Name
Maiden Name
Federal EIN Number
Street Address of Residence
City of Residence
State of Residence
Zip Code of Residence
Region of Residence
Country of Residence
Government ID
Date of Birth: mm/dd/yyyy
Social Security Number
Hire Date: mm/dd/yyyy
Citizenship Status
Employee Signature Date
Alien Identification (Registration) Number
Alien I-94 (Admission) Number
Alien Authorized to work until
Document Type
Issuing Authority
Document Number
Expiration Date (if any): mm/dd/yyyy
Preparer Name
Preparer Address
Preparer City
Preparer State
Preparer Zip Code
Preparer Date: mm/dd/yyyy
Company Name
Employer Name
Employer Phone
Employer Title
Employer Address
Employer City
Employer State
Employer Zip Code
Review Name
Reference Code
Second Reference Code
Package Name
Degree Type
Verification Type
Company City
Company State
Company Zipcode
Company Country
Name (First Last) While Enrolled
Start Date
End Date
Graduation Date
Company Name
Company Location
Company City
Company State
Company Zipcode
Company Country
Phone Number
Start Date
End Date
Company Contact
Name of Reference
Phone: 555-555-5555
Reference Type
Custom Question
Organization Name
License Type
License Number
Received on Date: mm/dd/yyyy
Expires on Date: mm/dd/yyyy
Company Name
Company Location
Phone Number
Start Date
End Date
Company Contact
Landlord/Management Company
Property Name
Property Address
Monthly Rent
Phone Number: 555-555-5555
Fax Number: 555-555-5555
Rental Start Date
Rental End Date
Years to Search
Reason For Test
Applicants Phone: 555-555-5555
Regulation Type
Credit Type
Spouse First Name
Spouse Middle Name
Spouse Last Name
Spouse SSN