Information for Camp Chihopi Staff

August 10-13, 2017

Providing a fun, rewarding and safe camp experience for the campers of Camp Chihopi is the primary goal of our exceptional staff. At Camp Chihopi, the staff strives to pay particular attention to the individual camper in an atmosphere of friendship, relaxation, and support. The camp is a well-supervised environment with 1 staff member for every 3 to 5 campers and with rules that apply to both campers and staff.

Camp Chihopi seeks volunteers who are enthusiastic role models for children, enjoy an outdoor environment, desire an opportunity for personal growth, and most importantly, who are compassionate in their interactions with children adapting to life after transplantation. Chihopi staff should have respect for each other and all campers, and display appropriate behavior by respecting personal property, promoting good sportsmanship and adhering to camp rules.

Download the Camp Chihopi Staff Forms:

Application Process

Please review the description for each role that interests you, then print the form(s) and complete the staff application for that position. After completing the application, please fax, scan/email, or “snail mail” to the addresses below. Completed applications must be received by Monday, June 26, 2017. In-person or telephone interviews for first-time applicants and CITs will be completed in early July.

CIT applicants please note: The application process for a CIT position has additional requirements. Please read the CIT application process carefully if you are applying for this position. If you have any questions, please call Bev Kosmach at 412-692-6115.

Send your completed application by Monday, June 26, 2017 to:

Beverly Kosmach-Park
Children’s Hospital of Pittsburgh of UPMC
Faculty Pavilion, 6th floor
4401 Penn Ave
Pittsburgh, PA 15224
Fax: 412-692-6116

Security Clearances

All Camp Chihopi staff 18 years and older must have security clearances within the last two years (valid to August 11, 2017). Staff who are accepted for positions at camp must submit their verified security clearances to Bev Kosmach by Friday, July 14, 2017. The University of Pittsburgh Medical Center mandates that security clearances be obtained every 2 years. There are no exceptions to this rule. Staff are strongly encouraged to begin the security clearance process as soon as possible as the process may take up to 8 weeks.

Camp Staff 18+ Years of Age

All camp staff 18 years of age and older should first complete and submit a State Police Criminal Record Check (PDF).

When your approved form is returned, then complete and submit the Act 33 Clearance Form (PDF) as instructed.

You must also complete the Act 73 Clearance Form online at

Act 34 Clearance Form: Request for Criminal Record Check

This record check can be completed by:

  1. Accessing the PA Criminal History website or
  2. Using the attached form on the Camp Chihopi website


Access the PA Criminal History website.

The website application is easy, quick, and self-explanatory. You should be able to complete and submit this form in less than 5 minutes.

  • Home page: click on the “Record Check” tab, top center of page
  • Then click “New record check”
  • For the drop-down “Reason for Request,” click on "Volunteer"
  • The $8 fee must be paid by credit card.

Paper form

Print and complete the form Request for Criminal Record Check (PDF).

  • On the right side of the form, 3rd section down, check the box: “Individual/criminal justice agency.”
  • Under the REASON FOR REQUEST section, check the last box “Volunteer.”
  • Enclose a certified check or money order (no personal checks or cash) for $10 payable to the “Commonwealth of Pennsylvania.”
  • Mail the Request for Criminal Record Check form to:
    PA State Police
    Central Repository – 164
    1800 Elmerton Ave.
    Harrisburg, PA 17110-9758

This form will be processed through the State Police, then returned to you.

Act 33 Clearance Form: Pennsylvania Child Abuse History Clearance

After receiving the processed “Request for Criminal Record Check,” (above) complete the Act 33 Clearance Form: Pennsylvania Child Abuse History Clearance (PDF).

  • Section 1: contact information, SS#, etc.
  • Purpose of clearance: check Volunteers
  • Previous names used
  • Previous addresses since 1975
  • Household members since 1975
  • Sign the form
  • Mail the following items:
    1. PA Child Abuse History Clearance (Act 33 Clearance)
    2. Processed Request for Criminal Record Check
    3. $10 money order (no cash or checks!) payable to the Dept of Public Welfare
  • The above items should be mailed to:
    Childline and Abuse Registry
    Dept of Public Welfare
    PO Box 8170
    Harrisburg, PA 17105-8170

Act 73 Clearance Form: FBI Criminal Background Check

Act 73 of 2007 requires that any prospective employee/volunteer of a child care service must obtain a fingerprint based FBI clearance in addition to the child abuse (Act 33) and Pennsylvania State Police criminal history record checks (Act 34). To comply with Act 73 requirements of Children’s Hospital of Pittsburgh of UPMC, please complete the following:

Payment Information

The fee for this record check is $25.75. No cash, personal, or business checks are accepted. This fee can be paid by:

  1. Money orders are made payable to Cogent Systems.
  2. Payment made online at using a credit or debit card


  • The applicant must register prior to going to the fingerprint site. Walk in service without prior registration will not be provided at any fingerprinting location.
  • Registration is available online 24 hours/day, seven days per week at
  • Telephone registration is available at 1-888-439-2486 Monday through Friday, 8 am to 6 pm EST.
  • During the registration process, all demographic data for the applicant is collected (name, address, SSN, etc.); there is no data entry required at the fingerprint collection site.

Log In

  • Access the website
  • Click on the Pennsylvania Department of Public Welfare (DPW) icon on the right side of the web page.
  • Under ‘Print Locations and Sites,’ click on the ‘Print Locations and Hours’ to find a site that is most convenient to you. Most of the sites are UPS stores. You may go to any site to have your fingerprints scanned. However, you must register through the Cogent website prior to going to a fingerprint location.
  • After deciding on a convenient location, you can begin the registration process.


  • Click on ‘Register Online’ located on the main DPW page. On the following Applicant Registration page, you will only need to complete all fields highlighted in yellow and marked with a red asterisk. Please note that for the field marked ‘Reason Fingerprinted’ you will need to select ‘Employment with Significant Likelihood of Regular Contact with Children’ from the drop down box. You are going to be a volunteer, but this is not a selection.
  • The applicant will pay a fee of $25.75 for the fingerprint service and to secure the Criminal History Record. Applicants may make their payment online at using a credit card or debit card. Money orders or cashier’s checks payable to Cogent Systems will be accepted on site for those applicants who do not have the means to pay electronically. No cash transactions or personal checks allowed.

Obtain Fingerprints

  • Report for your scheduled appt at the location that is convenient for you.
  • After completing the prints at the fingerprinting location, your background will be processed by the FBI and sent to the Department of Public Welfare (DPW). The DPW will then send you your results via the mail.
  • The original information sent to you via the DPW needs to be submitted to Bev Kosmach, Director, Camp Chihopi.

Submit Approved Act 33, 34, and 73 Forms

  • The processed PA Child Abuse History Clearance and Criminal Check will be returned to you in 4-8 weeks.
  • Copy the forms and fax (412-692-6116), scan/email (, or mail to:
    Bev Kosmach-Park
    Department of Transplant Surgery, 6FP
    4401 Penn Ave.
    Pittsburgh, PA 15224

For staff who do not live in PA:

COGENT is a fingerprinting and background check system used in PA that communicates with the FBI program, Integrated Automated Fingerprint Identification System (IAFIS). If you are a non-PA resident, you can google and find a location near your home where you can get your fingerprints processed through the IAFIS. There are many UPS stores that now have fingerprinting services. Google: UPS fingerprinting locations and your zip code or call your local police or state police office.

UPMC Employees

All UPMC employees were responsible for updating their security clearances as of September 2015, so are current for this year. UPMC requires employee clearances to be renewed every 3 years.

Medical Clearance

All staff who are transplant recipients must have routine labs done between May 1, 2017 and July 28, 2017 to attend camp. If you receive care at Children’s, your lab report will be accessed for you. You do not need to do anything. If you receive care through UPMC or another hospital in your local area, please have your lab results faxed by July 24, 2017 (412-692-6116). If your care is managed by a transplant center other than UPMC or Children’s, please have your doctor or transplant coordinator send a copy of your most recent check-up or medical assessment as well as a letter stating you are healthy enough to attend camp. These should be faxed (412-692-6116) to the attention of Bev Kosmach-Park, Department of Transplant Surgery, Children’s Hospital of Pittsburgh.


A mandatory orientation meeting will be held on Wednesday, August 9 from 6-8 PM at Children’s Hospital of Pittsburgh. More information will be sent to staff in mid-July. Staff are responsible for roundtrip transportation to Pittsburgh and lodging in the Pittsburgh area on Wednesday night, August 9.