UMN Program Submission Form

To be completed by University of Minnesota staff.

I verify that all program staff (faculty, staff, students including student employees, or volunteers) who are required to complete the U of M training on safety of minors and pass a background check have or will have done so within three years prior to the event. I also verify that this program has established practices for program activities that adequately address health and safety considerations for minors.
Months Offered
According to the start and end date, please select all the month(s) your program resides in.
Select all that apply.
Select one or more.
Program Location
Select campus/region.
Publish on website?
Have all covered staff/volunteers passed a background check?
Have all covered staff/volunteers gone through mandatory training?
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?
Will all program staff receive an orientation?
The orientation should include expectations for program staff behavior when interacting with, supervising, chaperoning or otherwise overseeing minors in program activities, recreational activities and/or residential facilities.
Have you planned appropriate physical environments to ensure quality learning environments and help prevent illnesses and accidents?
Is there a plan to change facilities or modify activities for participants with special needs?
Is there a plan to change facilities or modify activities in case of extreme weather?
Have you assessed the environment to determine if minors need to be accompanied to the bathrooms?
Environmental assessment may include considering the relative age of participants, the presence of minors or adults not from the same program, sight lines, and distance.
Is there a plan for the safe movement of minors?
Do minors attend without a parent or other caretaker?
Please review the health and safety requirements on this page:
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?
Do program staff know how to find and use this information?
Has the program established and communicated practices to prevent accidents and illnesses, including adequate first aid and proper handling of medications?
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?
Has the program established and communicated to program staff appropriate procedures for addressing emergencies, accidents and illnesses?
Will the program obtain a signed release of liability from all parents/guardians of minors prior to participation?
Does the program lodge people overnight?
More information on health and safety requirements can be found here:
Will the program follow lodging requirements?
More information on lodging requirements can be found here:
Will there be a minimum of two program staff on duty overnight who are 21 or older?
Has the program operated previously?
Were any incidents of suspected abuse known to have been reported to or by staff in the last year?
Was the incident reported to police, sheriff or local social service agency?
Did the incident allegedly occur during the program or involve program staff or volunteers?
If yes, contact the policy owner to review actions, including preventing future incidents.