Program Requirements Form Program Requirements Documentation Program Name: * Department Name: * Program Sponsor 1 Name: * Program Sponsor 1 Email: Program Sponsor 1 Phone Number: Program Sponsor 2/Advisor Name: * Program Sponsor 2/Advisor Email: Program Sponsor 2/Advisor Phone Number: Brief description of program activities: Are you incorporating College Knowledge activities? Mini Moments, Games, Campus Activities, Curriculum, and Panels Physical Activity Level * Low Moderate High Explain Physical Activity Level: Lab Activity Yes No Other If Yes or Other, please explain: Program Length? * Number of days per session. Number of Sessions: * 1 2 3 4 5 6 7 8 9 10+ Third Party? Yes No All third party programs are expected to hold a contract with the University, secure their own background checks, and submit a copy of their Certificate of Insurance to UYP. If Third Party, please check all that will be required of the program: Contract with the University Certificate of Insurance Overnight Stay? * Yes No Base Tier Level: * Tier 1 Tier 2 Tier 3 Other Tier 1 - Lower Risk: May include but are not limited to short (less than 4 hours) day camps, tours, or low risk activities Tier 2 - Moderate Risk: May include but are not limited to activities using specialized equipment, programs lasting longer than 4 hours, or programs that have moderate level of physical activity. Tier 3 - Higher Risk - May include but are not limited to overnight stays, sport activities, or activities in laboratories. If Other, please explain: Application Type: * Campus Programs for Minors Application (CPM) Events with Minors Application (EMA) Single Participant Lab Program Application (SPLPA) Other If Other, please explain: Insurance: * Not securing insurance Securing insurance through UYP Securing insurance on their own through TAMU or TAMUS Securing insurance on their own Other If Other, please explain: Support Service Fees * Yes No Other Support Service Fees Type Non-Sport Base Non-Sport Overnight Non-Sport Int'l Sport Base Sport Overnight Sport Int'l Third Party Program Other n/a If Other, please explain: Requiring Background Checks? * Yes No Notes on Background Checks: Requiring Child Protection Training? * Yes No TDSHS State Reportable? * Yes No Other Notes on CPT: TDSHS Deadline * Five (5) business days prior to the start of the program Prior to the start of the program Other Notes on TDSHS: Please check all that will be required of the program: Liability Waivers Terms of Use Talent Release Marketing Materials be submitted to UYP Overnight supervision protocol Hydration/Heat Stroke Plan Supervision Ratios Means to identify staff and participants 60 Day Deadline Program Director/Sponsor Annual Training All programs are expected to have a missing participant protocol, submit an itinerary to UYP, Check-in/Check-out procedures, have at least two staff members signed up for Code Maroon, a medical response plan, and are required to submit incident reports within 24 hours of an incident. * The program sponsor has been informed of these additional requirement. Other Requirements: Additional Notes: If you are human, leave this field blank. Submit
