Agency Letterhead




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(Agency Letterhead)
(Date)

Director


LDSS

Street Address,

City, State, Zip
Subject: Non-Conviction Letter
Dear
In accordance with the Code of Virginia (Code), § 63.2-1721 a criminal background check was conducted on the foster and/or adoptive parent with our agency. The results of the fingerprint-based checks of the National Crime Information Database (NCID) and as verification that a search of the Child Abuse and Neglect Central Registry as required in § 63.2-901.1 are listed below. This letter is verification that the foster and/or adoptive parent has not been convicted of any offenses cited in §63.2-1719 of the Code, including those specified for child welfare agencies and foster and adoptive homes approved by child-placing agencies.
Current Certification Period:

Date Original Certificate Issued:


Foster Parent Name:

Date of Results National Background Search

Date of Results Child Abuse and Neglect Central Registry
Additional Foster Parent Name:

Date of Results National Background Search

Date of Results Child Abuse and Neglect Central Registry
Please list other adults in the home if applicable.

_______________________________

Agency Representative

__________________________________________



Signature Date


032-02-0506-01-eng (03/15)


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