Youth Program Training Verification Form

Youth Program Name*

Employment Status*

Select

Name*

Email*

Phone Number (work # preferred)*

Name of Contact at Youth Program*

Email of Contact at Youth Program*

Data Authorization*

I authorize that all information provided on this form, including any and all personal, financial and academic data may be shared with the LSU Risk Management and university insurance carriers and vendors. This data will be securely retained indefinitely. To learn more about privacy at LSU, please see the LSU Privacy Statement.

By submitting this notice of completion, I hereby confirm that I have carefully read through the Basic Training for Adults Working in Youth Programs information. I additionally verify that I understand and will comply with the conduct and reporting requirements expected of me as an adult working in an LSU supervised youth program or a non-LSU youth program. I also authorize that my above information may be shared with LSU's Office of Risk Management to facilitate the Youth Protection Program.

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