Check YES to all that apply	Check NO to all that do NOT apply	Crime	Self	Other household member	Date of conviction, guilty plea, no contest plea or pending charges	Sentence
YES☐	NO☐	18 Pa.C.S. § 6320 (relating to sexual exploitation of children)	undefined	NO	undefined	undefined
YES☐	NO☐	23 Pa.C.S. § 6114 (relating to contempt for violation of protection order or agreement)	undefined	NO	undefined	undefined
YES☐	NO☐	Driving under the influence of drugs or alcohol	undefined	undefined	undefined	undefined
YES☐	NO☐	Manufacture, sale, delivery, holding, offering for sale or possession of any controlled substance or other drug or device	undefined	NO	undefined	undefined
YES☐	NO☐	18 Pa.C.S. Ch. 30 (relating to human trafficking)	undefined	undefined	undefined	undefined
YES☐	NO☐	18 Pa.C.S. § 5902(b.1) (relating to prostitution and related offenses)	undefined	NO	undefined	undefined

Sentence_18 Pa.C.S. § 6320 (relating to sexual exploitation of children) (format: password)

Date of conviction, guilty plea, no contest plea or pending charges_23 Pa.C.S. § 6114 (relating to contempt for violation of protection order or agreement)

Sentence_23 Pa.C.S. § 6114 (relating to contempt for violation of protection order or agreement) (format: password)

Date of conviction, guilty plea, no contest plea or pending charges_18 Pa.C.S. § 6320 (relating to sexual exploitation of children)

Text Field: Date of conviction guilty plea no contest plea or pending chargesDriving under the influence of drugs or alcohol(PlCH)

Text Field: Date of conviction guilty plea no contest plea or pending chargesDriving under the influence of drugs or alcohol(PlCH)

Text Field: SentenceDriving under the influence of drugs or alcohol(PlCH)

Date of conviction, guilty plea, no contest plea or pending charges_18 Pa.C.S. Ch. 30 (relating to human trafficking)

Sentence_18 Pa.C.S. Ch. 30 (relating to human trafficking)

Date of conviction, guilty plea, no contest plea or pending charges_18 Pa.C.S. § 5902(b.1) (relating to prostitution and related offenses)

Text Field: SentenceDriving under the influence of drugs or alcohol(PlCH)

Sentence_18 Pa.C.S. § 5902(b.1) (relating to prostitution and related offenses) (format: password)