Minors on Campus - External Organization Activity/Program Registration

The University of New Mexico is committed to the safety of all members of its community. UNM has particular concern for potentially vulnerable populations, including minors, who may require special consideration and attention. In the spring of 2016, UNM enacted University Administrative Policy (UAP) 2205: Minors on Campus, establishing general standards for minors participating in University programs and visiting University workplaces and classrooms. The HSC Institutional Compliance Program is here to assist all HSC Health System and Academic entities in appropriately registering activities and events involving minors on campus. For the purpose of safety and protection of privacy, activities and programs involving the following will not be approved: • Unaccompanied work in wet lab • Access to wet labs after normal business hours or weekends • Work with animals • BSL-2 or BSL-3 research work • Observation of clinical patients or research participants in clinical trials For more information please contact the HSC Institutional Compliance Program at (505) 272-7371 or aculpepper@salud.unm.edu. [Please Note: this form will automatically reload for multiple submissions.]

Name of Group or Organization*

Type of Group/Organization*

Select or enter value

External Primary Point of Contact*

External POC Email*

POC Direct Phone #*

Did the group/organization provide a Certificate of Liability Insurance*

Yes

Liability Insurance (TULIP)

Please ensure that all outside agencies provide proof of Liability Insurance of one million dollars. If agency does not have insurance please visit https://srs.unm.edu/risk-services/liability-insurance.html for further information or to obtain a quote.

Activity/Event Title*

Description*

If you have a program description in pre-written format, you may attach a MS Word or PDF File. However, please indicate in the box below that you've attached a file. (e.g. "description attached")

File Attachments

Drag and drop files here or

Program Dates*

MM/DD/YY (03/11/19; 03/17-19/19)

What is the Frequency of the Activity/Program?*

Check all that apply

Select or enter value

Type of Activity/Event*

Select or enter value

Participant Age*

Select

Program Location(s)*

Select or enter value

Number of Minor Participants*

Authorized Adults

Please make sure all Authorized Adults and any individual having direct contact with Minors have completed a criminal background checks via the UNM Background check process at https://hr.unm.edu/background-checks-request

UNM HSC Point of Contact*

Department/Unit*

UNM HSC POC Email*

UNM HSC POC Phone #*

Submission Date*

Attestation of Compliance

By clicking submit, I acknowledge that all information in this form is true, accurate, and complete.

Send me a copy of my responses

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