UMN Program Submission Form: Submission #964

Submission information

Submission Number: 964

Submission ID: 4826

Submission UUID: 7183df02-35b8-478c-b6dc-837130c5c8a4

Submission URI: /program-submission-form

Created: Tue, 03/12/2024 - 13:42

Completed: Tue, 03/12/2024 - 13:42

Changed: Fri, 03/15/2024 - 14:22

Remote IP address: 172.69.59.145

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 Campus visit for West Metro Summer School

Unit Psychology

Link to Program Registration N/A

Description A teacher contacted our department and asked us to host a campus visit. 3-4 labs are going to be offering lab visits/activities. The classroom teacher will be with the students at all times, so none of our presenters are doing background checks.

Phone 612-626-7607

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

Program Director/Leader Cheryl Olman, Chair of Department of Psychology Public Engagement Committee

Program Leader Email [email protected]

Program Information

Start Date Tue, 06/25/2024 - 00:00

End Date Tue, 06/25/2024 - 00:00

Months Offered Jun

Age 10, 11, 12, 13

Estimated number of participants 15

Subject Science, Technology, Engineering, and Math

Program Location 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 applicable

Have all covered staff/volunteers completed the Safety of Minors mandatory training via the Training Hub? Yes

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? 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? No

Notification Date Tue, 03/12/2024 - 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