UMN Program Submission Form: Submission #980

Submission information

Submission Number: 980

Submission ID: 4906

Submission UUID: 6bc11605-6c94-442b-b9e8-76719f745565

Submission URI: /program-submission-form

Created: Fri, 04/12/2024 - 07:27

Completed: Fri, 04/12/2024 - 07:27

Changed: Mon, 04/22/2024 - 12:06

Remote IP address: 172.70.131.39

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 Breck - Two Week Unpaid Internship - Dr. Pakhomov

Unit Pharmaceutical Care & Health Systems

Link to Program Registration Recommended Only

Description Dr. Pakhomov will offer a two week unpaid internship to a Breck student to work on AI database with un-identifiable human data information.

Phone 6123541601

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

Program Director/Leader Dr. Serguei Pakhomov

Program Leader Email [email protected]

Program Information

Start Date Wed, 05/15/2024 - 19:00

End Date Tue, 05/28/2024 - 19:00

Months Offered May

Age 17

Estimated number of participants 1

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 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? 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? 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? Yes

Has the program established and communicated practices to prevent accidents and illnesses, including adequate first aid and proper handling of medications? Yes

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? Yes

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? Yes

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

Notification Date Fri, 04/12/2024 - 00:00

Will a minor be present in lab environment? No

Virtual Program Information

Is this a virtual program? No

I agree to the terms of service. Yes