Please list all volunteers, faculty, staff and (adult) students who will be participating in the event and verify they have read Appendix A of the Protection of Minors Policy, titled “Training Requirements for Those Working With or Near Minors.” Please indicate that you have collected the signed certification (contained within Appendix A) from every participant. Attach documentation with additional names and certifications if necessary.

The following categories of individuals are required to have undergone a criminal background check within four (4) years of their participation in university-run or -affiliated programs or activities involving minors:

• Directors and supervisors of programs and activities involving minors, including those who are responsible for supervising individuals who interact with minors.
• Those who stay overnight with minors as part of their job responsibilities in programs or activities involving minors.
• Those who regularly spend time alone with minors as part of their job responsibilities or in their role in programs or activities involving minors.

University Human Resources will oversee the processing of and payment for criminal background checks. Note that results must be received prior to each individual's participation. If a new background check is required, allow for at least 10 business days prior to the start of the program or activity for background check completion.

Any items identified in the background check that remotely pertain to the protection of minors must be discussed with the university department or unit allowing the event. The department or unit contact will discuss the results of the background check with other university officials to ensure that a decision will be made regarding the participation of the individual in question.

Please list all volunteers, faculty, staff and (adult) students who will be participating in the event and verify they have had their background checks completed and verified. Attach documentation with additional names and certifications if necessary.

Please retain a copy of this signed form for department records and email a scanned copy to hr@172ty.com. The completed form must be submitted at least two (2) business days prior to the event. Thank you.