Public Safety Minor Registration Form Part 1: Activity Coordinator (Primary Albright College Contact Overseeing Activity) * First Name * Last Name: * Title * Department * Division/College * E-mail Address * Phone Please list full names and emails of anyone else (ex: supervisor, colleague) you wish to be CCed on communication: Part 2: Program Information * Name of Activity * Please describe the activity in as much detail as possible * Location(s) of activity (include street, city, state, zip code for each location: e.g. 3141 Chestnut St, Philadelphia, PA 19104 or specific virtual platform if online, write TBD if unknown) * Days/dates/times of activity (e.g. Friday, January 17, 2020 from 8am-5pm or Mondays from 3pm-4:30pm from October 2020 through June 2021) Is Albright working with any external entities (non-profit organization, company, etc.) to deliver the program? If so, please clearly explain the role of the external entity. Estimated number of minors Early childhood students (infant – Pre-K) Elementary students (grades K-5) Middle school students (grades 6-8) High school students (grades 9-12) Does the activity require overnight housing? YesNo Does the activity require Albright transportation? YesNo Will the program require each minor’s parent/guardian to accompany the minor the whole time? YesNo Part 3: Authorized Adults PEBC Authorized Adults Template All individuals participating in the activity are required to have fully complied with state law and Albright College policy concerning Background Checks/Clearances and Protection of Minors/Mandated Reporting of Child Abuse Training. Please complete the Excel template linked above and email to ryoung@albright.edu for all individuals who will have any interaction with minors during the activity. A few notes about this process: Carefully consider the question “Is this individual expected to participate in the activity as part of their employment with Albright College? This will help our team distinguish if the individual needs clearances for employee or volunteer purposes.” If involvement in this activity is part of an employee’s paid job, clearances for employment purposes are needed if not already on file. If the individual is unpaid or the activity is above and beyond their paid job description, the individual will need clearances for volunteer purposes. (Clearances obtained for employment purposes may be used for volunteer purposes but not vice versa.) Please note that your cost center will incur the cost of any clearances not already on file with Human Resources. Human Resources is not able to run the process without a cost center. If you’re unsure what your cost center is, ask your supervisor or financial manager. If there are individuals who you believe might be exempt from needing the PEBC based on their very limited role, please make a note on the tracker or email ryoung@albright.edu clearly explaining their role. Human Resources will gather additional information if necessary and make a determination. Part 4: Approvals By selecting this checkbox, I verify that I, the Activity Coordinator, have reviewed and approved this activity. By selecting this checkbox, I verify that this activity has been reviewed and approved by the dean/department head (enter name of dean/department head and date of approval below). * Dean/Department Head Name & Date * Please enter the red letter from the image below:
