Minors Program or Activity Registration for "Covered Third Parties"
“Covered Third-Party Program” refers to a Program or Activity operated by an entity other than the University which primarily serves or includes Minors and uses NC State University Property. Covered Third Parties must complete this form to register the Program or Activity with the Office of Youth Programs and Compliance as required in REG 01.25.18. Make sure to read REG 01.25.18 and ask questions for clarification prior to completing the form. For questions, contact protectionofminors@ncsu.edu.
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Email *
Name of the Organization *
Name of the Program or Activity *
First and last name of the person responsible for the Program or Activity. *
Phone number where the responsible person can be reached during the proposed activity with minors. *
E-mail address of the responsible person. *
Name of the NC State venue(s) or property *
First and Last Name of the NC State venue representative(s) *
E-mail address of the NC State venue representative(s). *
Phone number of the NC State venue representative(s). *
Describe the Program or nature of the Activities to be undertaken. *
What is the start date the Program or Activity? *
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What is the end date of the Program or Activity? *
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If this is a re-occurring Program or Activity, please describe.
How many Minors will participate? (Respond with an estimated total number.) *
What age range are the minors?  If unknown, list the grade or year in school. *
How many adults will be serving as "Covered Individuals" for the program or activity? "Covered Individual" means all individuals 18 years old or older who work closely with, interact, supervise, instruct, or otherwise come into direct, non-incidental contact with Minors in a Program/Activity. *
Where will the Program or Activities take place?  List all locations.   *
Provide a hyperlink to the agenda including times, locations and room numbers where applicable. Share with protectionofminors@ncsu.edu. *
Minors must be supervised at all times on NC State's campus.  Describe your supervision plan.  Include transitions from place to place, mealtime, downtime and overnight if applicable. *
The Program must provide training per REG 01.25.18 to staff and volunteers.  You can provide your own, or use the NC State training under the training heading on this page. If you provide your own, please describe the topics covered or link to it in the space provided. *
I have read and agree to the Personal Boundaries for working with minors.(https://vptm.ehps.ncsu.edu/minors/best-practices/) *
Required
I understand that all suspected child abuse or neglect must be reported according to North Carolina Law. *
I have signed a Facilities Use Agreement with NC State for the Program's use of the property. *
I have read and understand the Program's responsibilities under REG 01.25.18 and agree to follow all applicable policies, regulations and rules. *
I understand that all "Covered Individuals" must have a current background check per REG 01.25.18. *
I understand the Program must provide training per REG 01.25.18 to staff and volunteers and that NC State may recommend additional safety-related trainings based on the Program or Activities described. *
I understand that the University may monitor the Program's compliance with REG 01.25.18. *
A copy of your responses will be emailed to the address you provided.
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