Youth Program Information

A youth program is a program or activity designed for non-Georgia Tech student minors organized and run by Georgia Tech, or organized and run by third-party entities utilizing Georgia Tech facilities. Some examples of youth programs include, but are not limited to: day and overnight camps; tutoring/mentoring in local schools; Internships or shadowing experiences for a minor in labs/research facilities.

Program Name:

* The program name must match space reservation requests, and facilities use agreement if applicable.

Program is organized/facilitated by:

Georgia Tech Office/Department/College/Registered Student Organization

Third Party using Georgia Tech Facilities

Sponsoring Georgia Tech Office/Department/Student Organization:

Are you working with a third-party entity on the program?

Yes

If so, in what capacity?

What is the name of the organizing entity?

*The name of the organizing entity must match on the registration form, facilities use agreement and certificate of insurance.

Certificate of Insurance

Please upload your Certificate of Insurance. Click here to see the COI requirements found in the Facilities Use Agreement.

One file only.
500 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.

Program web site address:

Do not include the http(s):// protocol.

Who is the facility contact for the location of the youth program
(https://space.gatech.edu/sites/default/files/documents/GT_Campus_Buildings.pdf):

Name:

Email:

Description of Program:

*The description should serve as a brief summary of the purpose of the program, and include the number of times the program occurs (Ex: Program occurs once a week for 8 weeks over the summer, or, program occurs once in the fall and once in the spring).

Program Schedule:

*The schedule must include all dates, requested locations, and include all projected activities and program times. All time during the program must be accounted for within the submitted schedule. EX: If the program occurs overnight, “lights out” and when participants are expected at breakfast must be included. The schedule must also note if any participants will interact with any of the following: 3D printing, animal dissections, chemical and/or biological agents, soldering or other heating elements, and/or utilization of a laser. Georgia Tech Environmental Health and Safety approval or exemption may be required prior to Youth Programs approval. If the same program occurs multiple times you can indicate this on the schedule.
One file only.
4 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.

Is the program free of charge for participants?

Yes

Other (Please describe)

Describe Reason

Youth Programs are required to submit registration forms at least 30 days in advance of the program start date. If there are extenuating circumstances, and you are submitting for a program within 30 days, email youthprograms@gatech.edu and cc’ the facility manager in the communication outlining the reason for the extenuating circumstance and late submission.

Start Date:

Note: Programs are not allowed to start until written Youth Programs Compliance Approval is issued.

End Date:

Will the Program include an overnight stay?

Yes

Will the Program utilize Georgia Tech laboratories?

*Environmental Health and Safety approval or exemption may be required for activities in Georgia Tech laboratories.

Yes

What laboratory/ies will be utilized during the program?

Will the Program provide transportation to minors at any time?

Yes

Youth Program Location (please include name of location and address)

Campus

GT Atlanta Campus

GT Satellite Campus/Office

Off Campus

Primary Location:

Street Address, City, State

Primary Building

Street Address, City, State

Participant Supervision Information

The Georgia Tech Youth Programs Policy requires Appropriate staffing and supervision ratios by age range in accordance with American Camp Association standards. Generally, one-on-one interactions with minors are prohibited. If one‐on‐one interaction is required, it will take place in open, well illuminated spaces or rooms with windows observable by other authorized adult or program staff, unless the one‐on‐one interaction is expressly authorized by the program administrator or is being undertaken by a health care provider.

Approximate number of minors per program occurrence:

Total number of minors across all program occurrences (if the program occurs more than once):

Minimum Age of Minor Participants:

*Ages or grade levels are acceptable for this field.

Maximum Age of Minor Participants:

*Ages or grade levels are acceptable for this field.

Who will chaperone the minor participants?

Approximate number of chaperones per program occurrence:

Total number of chaperones across all program occurrence (if program occurs more than once):

Program Contact Information

If the youth program is being organized by a third-party a representative of that entity must be listed as the primary and on-site contacts.

Program Contact Name:

Program Contact Email:

Program Contact Number:

Program Contact Role:

On-Site Contact Name:

On-Site Contact Email:

On-Site Contact Cell Phone Number:

On-Site Contact Role:

Youth Program Requirements Reminder
All youth programs must consider and meet the following criteria in the planning of the program.

By checking off each box you attest that requirements will be completed prior to the start of the program. GT employees operating non-compliant youth programs may be subject to disciplinary action.

If you have questions please contact our office youthprograms@gatech.edu for further guidance.

Pre-screening, background checks, and training of individuals with direct contact with minors

Appropriate staffing and supervision ratios by age range in accordance with American Camp Association standards

Safety and security planning including but not limited to: knowledge of facility evacuation plans and shelter in place locations, participant check-in and check-out procedures, and enrollment of the on-site contact in the Georgia Tech Emergency Notificati

Protocols for injury, illness, medication storage, missing participants, participant misconduct and staff misconduct

Transportation and housing needs

Participation registration forms including but not limited to waivers, pick-up authorization documentation, and emergency contact information.

Licensing requirements of state and federal agencies

Accept Policy Terms

Policy Terms

Click here to indicate that you have read and agree to the above policy.

You may also read and print the policy from the Georgia Tech policy library here: Youth Programs at Georgia Tech Policy

Prepared or Submitted by:

On Behalf of:

This field should be completed if the youth programs registration form was completed and submitted on behalf of another person.

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Youth Program Information

Participant Supervision Information

Program Contact Information

Georgia Institute of Technology

2023 - 2024 Youth Program Registration Form

Youth Program Information

Participant Supervision Information

Program Contact Information