Developmental Home Fingerprint Clearance Card Tracking Portal
This portal is only to be used by DDD Qualified Vendors providing developmental home services. Enter the name, date of birth, and date of fingerprinting for each developmental home applicant/licensee who has applied for a fingerprint clearance card under the direction of your agency. Adult household members of developmental home providers should also be included. Please enter each applicant's name as it appears on their drivers license or other state or federal identification. The form will accept six applicants at a time.

Names must be submitted within 10 days of fingerprinting.
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Email *
Qualified Vendor Name *
Qualified Vendor Assists ID Number *
Name of Individual Completing this Form *
Phone Number of Individual Completing this Form *
Applicant 1 - Name (First and Last) *
Applicant 1 - Date of Birth *
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DD
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YYYY
Date Applicant 1 was fingerprinted? *
MM
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DD
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YYYY
Applicant 2 - Name (First and Last)
Applicant 2 - Date of Birth
MM
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DD
/
YYYY
Date Applicant 2 was fingerprinted?
MM
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DD
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YYYY
Applicant 3 - Full Name (First and Last)
Applicant 3 - Date of Birth
MM
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DD
/
YYYY
Date Applicant 3 was fingerprinted?
MM
/
DD
/
YYYY
Applicant 4 - Full Name (First and Last)
Applicant 4 - Date of Birth
MM
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DD
/
YYYY
Date Applicant 4 was fingerprinted?
MM
/
DD
/
YYYY
Applicant 5 - Full Name (First and Last)
Date Applicant 5 was fingerprinted?
MM
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DD
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YYYY
Applicant 5 - Date of Birth
MM
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DD
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YYYY
Applicant 6 - Full Name (First and Last)
Applicant 6 - Date of Birth
MM
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DD
/
YYYY
Date Applicant 6 was fingerprinted?
MM
/
DD
/
YYYY
Submit
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