PNSMOC Policy Acknowledgement
June 2017
Albany State University
Protection of Non-student Minors on Campus
Policy Acknowledgment Form
For Employees, Students, & Volunteers
Instructions: Please sign and return this form to the Albany State University Program Sponsor for your
assigned activity. Please retain a copy for your personal records.
All
Albany State University (ASU) employees, students, and volunteers who work in programs serving non-
student minors who are reasonably anticipated to have direct contact or interaction with minor program
participants are required to complete annual training each fiscal year before
they begin working with
minors in programs sponsored by ASU and/or hosted on ASU campuses and properties.
Affil
iation (select one): Employee Student Volunteer
Loca
tion of the Policy – I acknowledge that I have been informed that the ASU Protection of Non-student
Minors on Campus Policy which is available on the ASU website at: https://www.asurams.edu/Legalaffairs/
Notification of Future Changes – It is my responsibility to read and comply with the policies and
procedures contained in the ASU Protection of Non-student Minors on Campus Policy. I understand that the
policies and procedures contained in it may change without prior notice. I understand that notification of
changes or additions to these policies and procedures will be made to employees, students, and volunteers
who work in programs serving non-student minors who are reasonably anticipated to have direct contact or
interaction with minor program participants. I understand that efforts will be made to communicate
significant changes in a timely manner and that such revisions may supersede, modify, or eliminate existing
policies, procedures and benefits. The policy may be updated from time to time, and I may be notified via e-
mail, without the need to sign this form again.
Authority of the Policy – I understand that the purpose of this policy is to assure the appropriate
supervision of non-student minors that visit ASU and to set out the appropriate procedures to be followed
by non-ASU entities in order to host events which include non-student minors on property owned by or
leased by ASU, or in an ASU-sponsored program at other locations. I also understand that ASU is committed
to maintaining a safe environment which promotes the safety and welfare of all non-student minors that
participate in programs held on our campus. I understand that ASU offers a variety of camps, clinics, and
activities that bring non-student minors onto our campus. These include but are not limited to athletic
camps, after school programs, science camps, music, and enrichment programs. I understand that these
programs are of great educational value and serve to benefit both the institution and the larger community.
Ack
nowledgement of Policy – I hereby acknowledge that I have read the ASU Protection of Non-student
Minors on Campus Policy for all Albany State University employees, students, and volunteers. I recognize
and understand that this policy serves to protect the non-student minors that participate in these programs
and preserve the positive impact they have on our community. I acknowledge that I will abide by the policy.
Name (
Print): ________ Signature:
_____
Ema
il Address: Date:
