UMN Program Submission Form: Submission #897

Submission information

Submission Number: 897

Submission ID: 4491

Submission UUID: bc29cb36-d9ca-48bd-8189-e7bf9e1d8375

Submission URI: /program-submission-form

Created: Mon, 10/16/2023 - 12:54

Completed: Mon, 10/16/2023 - 12:54

Changed: Mon, 10/16/2023 - 12:54

Remote IP address: 162.158.137.36

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 CBS Outreach

Unit CBS Outreach and BMBB

Link to Program Registration N/A

Description 30 8th grade students from Heritage Washington Tech school will be visiting campus on November 17 from 9:30-1. They will be touring labs in Gortner and Cargill as well as visit the Conservatory. They will be with their classroom teacher at all times.

Phone 612 626 6281

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

Program Director/Leader Burckhard Seelig

Program Leader Email [email protected]

Program Information

Start Date Thu, 11/16/2023 - 18:00

End Date Thu, 11/16/2023 - 18:00

Months Offered Nov

Age 12, 13, 14

Estimated number of participants 30

Subject Science, Technology, Engineering, and Math

Program Location Twin Cities/Central MN- In-person

Publish on Youth Central website? No

Staffing Information

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

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

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? Not applicable

Will all program staff/volunteers/student workers receive an orientation? Not applicable

Safety of Minors Information

Have you planned appropriate physical environments to ensure quality learning environments and help prevent illnesses and accidents? Yes

Is there a plan to change facilities or modify activities for participants with special needs? Yes

Is there a plan to change facilities or modify activities in case of extreme weather? Yes

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? No

Does the program lodge people overnight? No

Has the program operated previously? Yes

Were any incidents of suspected abuse known to have been reported to or by staff in the last year? No

Notification Date Mon, 10/16/2023 - 00:00

Will a minor be present in lab environment? Yes

In addition to the general release and waiver form, has each participants' adult caregiver signed off on the Labs Use Agreement Form (Paid Lab activity) or the Volunteers/Guests in Labs Form? Yes

Are you prepared to give a safety overview of the lab space? Yes

Do you require any enrolled college students using the lab to complete a specific training safety module related to the lab activity? No

Do you need an additional HSRM risk assessment because chemicals, dust, fumes, vapors, gases, biological materials, radioactive materials or other substances may be present? No

Virtual Program Information

Is this a virtual program? No

I agree to the terms of service. Yes