PLEASE REGISTER YOUR PROGRAM PLEASE REGISTER YOUR PROGRAM Thank you registering your program. Upon submission of this form, please order background checks for persons that will have direct contact with minors. If you have any questions about this form, the Policy on the Safety of Children in University Programs, or background checks, please contact Kenyatta Tatum Futterman: firstname.lastname@example.org, 773.702.8837. Answers to your questions may also be found within this web site on the pages that review many questions and answers about the Policy and background checks. Thank you. Name of program Contact person Contact person's email address Contact person's telelphone number If Non-UChicago program, please state name of program and UChicago point of contact Department/Division/Unit/Lab University of Chicago unit responsible for program Center for Leadership and Involvement The University of Chicago Community Service Center Neighborhood Schools Program Department, academic unit, laboratory (please specify): Entity Not Associated With The University of Chicago If Non-UChicago program, does entity have a sit agreement, and/or facility use agreement? Yes No Overnight activity? Yes No Program start date Program end date How many UChicago faculty, academic appointee(s), staff, students, or volunteers will be supervising the program? How many minors will be served Which UChicago locations will be utilized to host minors? Ages Of Minors 5 years and under 5-8 years old 9-12 years old 13-15 years old 16-17 years old Upon submission of this form, the next step is to order background checks. Order background checks for persons with direct contact with minors. Direct contact means to provide instruction, care, supervision, guidance, oversight, and/or control over children through a covered program.