Child and Youth Protection Policy:
Request to Hold Sponsored Activity Involving Children
The State University of New York’s Child and Youth Protection Policy requires that covered activities (as defined below)
that involve children / youth under the age of 17 (“children”) meet certain requirements including the designation of an
official responsible for ensuring child protection, training of people with custody, control, or supervision of children and
ensuring that all such persons are not listed on the National and New York State Sex Offender Registry. Departments
that wish to sponsor activities, programs, or events that involve children should complete this form. A determination will
then be made as to whether the program is considered a covered activity and will be subject to the policy.
Covered Activities Definition: A program or activity sponsored or approved by the College or a College-affiliated
organization, or an activity conducted by a third-party organization, occurring on or off campus, for the duration of which
the responsibility for custody, control, or supervision of children is vested by the College, College-affiliated organization,
or third-party organization. This does not pertain to child-care centers located on College premises nor any instructional
activity directly related to enrollment in credit-bearing college courses.
Spon
soring Department: _______________________________________ Today’s Date: ____________________
Primary Contact Name: ___________________________________________________
Date o
f Activity: ___________________________ Time of Activity: (Start to Finish): _______________________
Descr
iption of Activity:
List a
ll Anticipated Locations Utilized: ________________________________________________________________________
Esti
mated Number of Children Involved with Activity: ___________________________
Number o
f Individuals Responsible for Custody, Control, or Supervision of Children:
____________________________
Does the ac
tivity involve an overnight? (Select One) YES NO
Does the ac
tivity require use of locker rooms (Select One) YES NO
Does the ac
tivity involve any 1-on-1 activities involving children? (Select One) YES NO
Name
of Person Completing Form: ________________________________
Cove
red Activity: YES NO If Covered Activity:
Activity Approved: YES NO N/A Training Materials Sent:_________________
Initials: __________ Covered Persons Form Sent:________________
Date Reviewed: _______________ Responsible University Official: _______________________
9/17/2019
