UMN Program Submission Form: Submission #603

Submission information

Submission Number: 603

Submission ID: 3021

Submission UUID: d4f3f794-295b-4bff-b0b5-9d635a9916de

Submission URI: /program-submission-form

Created: Sat, 04/30/2022 - 18:32

Completed: Sat, 04/30/2022 - 18:32

Changed: Mon, 05/09/2022 - 13:46

Remote IP address: 162.158.212.229

Submitted by: Anonymous

Language: English

Is draft: No

Webform: UMN Program Submission Form

Submitted to: UMN Program Submission Form

Please indicate which type of program you would like to submit: K-12 Youth Event/Program/Camp/Intern/Conference (In-Person and/or On line)

Basic Information

Program Title Department of Dermatology Clinical Research Experience for High School Student

Unit Department of Dermatology

Link to Program Registration NA

Description This program was an arranged experience between the student, her high school, and the Department of Dermatology at the University of Minnesota. The student will work with clinical research faculty and staff to learn about clinical research.

Phone 612-625-7692

Email (point of contact for participants) [email protected]

Program Director/Leader Maria Hordinsky, MD, Professor and Head, Department of Dermatology. Note - we are in the process of completing background checks and training.

Program Leader Email [email protected]

Program Information

Start Date Sun, 05/15/2022 - 00:00

End Date Tue, 05/31/2022 - 00:00

Months Offered May, Jun

Age 17

Estimated number of participants 1

Subject Health, Nutrition, and Human Development, Science, Technology, Engineering, and Math

Program Location Twin Cities/Central MN- In-person, Twin Cities/Central MN- Virtual

Publish on Youth Central website? No

Staffing Information

Have all covered staff/volunteers passed a background check within the last three years? Not yet

Have all covered staff/volunteers completed the Safety of Minors mandatory training via the Training Hub? Not yet

Will there be a minimum of two program staff on duty at all times who are 18 or older and two years older than the oldest participant? Yes

Will all program staff/volunteers/student workers receive an orientation? Yes

Safety of Minors Information

Have you planned appropriate physical environments to ensure quality learning environments and help prevent illnesses and accidents? Not yet

Is there a plan to change facilities or modify activities for participants with special needs? Not applicable

Is there a plan to change facilities or modify activities in case of extreme weather? Not yet

Have you assessed the environment to determine if minors need to be accompanied to the bathrooms? Yes

Is there a plan for the safe movement of minors? Yes

Do minors attend without a parent or other caretaker? Yes

Does the program collect and keep within easy access information on each participant including current medications administered during program time frame and contact information for parents/guardians? Yes

Do program staff know how to find and use this information? No

Has the program established and communicated practices to prevent accidents and illnesses, including adequate first aid and proper handling of medications? No

Does the program have emergency plans for fire, weather (e.g., tornado), toxic gas evacuations, unfamiliar packages, intruders, lost or missing children, and other emergencies? Yes

Has the program established and communicated to program staff appropriate procedures for addressing emergencies, accidents and illnesses? No

Will the program obtain a signed release of liability from all parents/guardians of minors prior to participation? Yes

Does the program lodge people overnight? No

Has the program operated previously? No

Notification Date Sat, 04/30/2022 - 00:00

Will a minor be present in lab environment? {Empty}

Virtual Program Information

Is this a virtual program? No

I agree to the terms of service. Yes