Felony conviction exception request

  • A criminal background check will is performed by RMHC-KC staff on all referred guests. Our policy is that any person with a felony conviction is ineligible to stay, unless an exception has been granted. If you would like to request an exception, please complete the following form, in full detail. If you need assistance completing this form, please call 816-541-8460. Please note: Without exception, no one with a criminal history of violence (including assault), sexual misconduct or abuse of a child is eligible to stay at the House.
  • MM slash DD slash YYYY
  • MM slash DD slash YYYY
  • First NameMiddle NameLast NameDate of Birth 
  • Offense/ChargeSentence/PunishmentDate of Conviction (Month/Year)Are you still on parole or probation?When were you released from jail/prison?City, State of Conviction 
  • This should always be the person with felony.