Re-screening Instructions

If you are paid by NDSU

Please complete the forms below within two weeks and return to the Extension Director's Office via mail or email. Do not include your social security number on the SFN433 form.

Morrill Hall 311, NDSU Dept. 7000, PO Box 6050, Fargo, ND 58108-6050 or email misty.fry@ndsu.edu. 

1. Code of Conduct (Form)

 2. Child Abuse and Neglect Background Inquiry for NDSU-Paid Staff (SFN433 )

3. Confidentiality Agreement (Form H)

Complete Form H if you handle confidential records of volunteers, paid staff or 4-H members.

The Director’s Office will conduct the re-screening with the Department of Human Services (DHS), enter the date that DHS signed the form in the Ag Info Center’s People database, then file all forms in the employee’s secure personnel file in the Ag Budget Office.

If you are paid by your county

Please complete the forms below within two weeks and give them to the Extension county coordinator in your office. Do not include your social security number on the SFN433.

1. Code of Conduct (Form)

2. Child Abuse and Neglect Background Inquiry for County-Paid Staff (SFN433)

3. Confidentiality Agreement (Form H)

Complete Form H if you handle confidential records of volunteers, paid staff or 4-H members.

The county coordinator will place Forms A and H in a secure office file, i.e. locked cabinet or cabinet in locked room.

Next the county coordinator will complete Part II of the SFN433 form with his/her contact information then submit the form to the address at the bottom of the form using fax, USPS mail or email for screening on the North Dakota Child Abuse Information Index. Department of Human Services (DHS) will do the screening, sign the form, then return it to the county coordinator.

The county coordinator will relay to the Extension Director’s Office the date that DHS signed the form, then file the form with Forms A and H in the secure office file. The Director’s Office will enter the date that DHS signed the form in the Ag Info Center’s People database.