Minors on Campus Program Registration

Name*

First NameLast Name

Email*

example@example.com

Phone Number

Area CodePhone Number

Department/Unit/Organization

Program Name

Are you the Program Administrator?*

YesNo

Program Administrator Name*

First NameLast Name

Program Administrator Email*

example@example.com

Program Administrator Phone Number

Area CodePhone Number

Will the program administrator be present on-site for the full duration of the event?*

YesNo

Please provide the name, email address, and phone number of the individual who will be on-site for the full duration of the event.

Program Website

Social Media (URL)

How will your program be held?*

VirtualIn PersonOther

Program Date & Times*

Program Description including Minor specific participation/roles:

Number of faculty, staff, students, volunteers, etc. who will be supervising minors:

Number of Minors participating

Ages participating (select all that apply):

Population(s) served (1st gen, low income, underrepresented, etc.):

Does your program require overnight stay at the University? If yes, please make sure to consult BookEMU.*

YesNo

Will any of your program staff be transporting minors, either alone or in groups?*

YesNoOther

Please enter the full names of any staff who will be transporting minors. These staff will need to undergo an additional driving record check.*

Have all program faculty, staff, students, and volunteers who will be participating in your program undergone EMU background checks?*

YesNo

Please ensure you submit all faculty, staff, and students who still need to undergo background checks for your program on the following page.

Have all program faculty, staff, students, and volunteers completed required Minors on Campus training?*

YesNo

Please ensure all faculty, staff, and students complete the training. All individuals submitted on the Background Check form will receive an invitation to complete the Minors on Campus training.

As a program administrator, have you registered for EMU’s Rave emergency alerts (email/text notifications) or downloaded the Eagle Ready Safety App (no data plan required)?*

Yes, I have signed up for Rave emergency alertsYes, I have downloaded the Eagle Ready appYes, I have signed up for Rave emergency alerts and downloaded the Eagle Ready appNo, I have not signed up for Rave emergency alerts or downloaded the Eagle Ready app

Please sign up for Rave Mobile Safety or download the Eagle Ready app by copying and pasting the following link into your browser: https://www.emich.edu/eagle-alerts/index.php. IMPORTANT: You will not be able to submit this form until you have indicated that you have signed up for Rave emergency alerts or downloaded the Eagle Ready app. By Initialing here, you affirm that you have signed up for Rave emergency alerts or have downloaded the Eagle Ready app.*

By Initialing here, you affirm that all information provided on this form is true and correct to the best of your knowledge. If there are any changes, you will reach out to the Office of Engage (emu_engage@emich.ed) to provide updates.*

Minors on Campus Program Registration

Background Check Form