Ashland University
Protection of Minors Policy
University Sponsored Event Roster/Checklist

This form is to be used for events that are sponsored by Ashland University that fall under the Protection of Minors Policy.

Name of Event:____________________________________

Sponsoring Department or Unit:__________________________

Date/s of the Event:____________________________________


Please list all volunteers, faculty, staff, and students (any adult) that will be participating in the event and verify they have read Appendix A of the Protection of Minors Policy – "Training Requirements for Those Involved with Minors". Please indicate that you have collected their "Certification", which is within the Policy. Attach additional lines, if necessary.

Adult's Name Certification Received √


The following categories of adults are required to have undergone a criminal background check within four (4) years of their participation in University activities or programs involving minors. Note that results must be received prior to the individual's participation in the program. Human Resources can validate criminal background check completion and will coordinate the process for University-sponsored events. IF A NEW BACKGROUND CHECK IS REQUIRED, ALLOW FOR AT LEAST TEN (10) BUSINESS DAYS PRIOR TO THE START OF THE PROGRAM FOR PROCESS COMPLETION.

Adult's Name Background Check Completed/Verified √
  • Directors and supervisors of programs involving minors, including those who are responsible for supervising those who interact with minors;
  • Those who stay overnight with minors as part of their job responsibilities in a program or activity involving minors; and
  • Those who regularly spend time alone with minors as part of their job responsibilities or role in a program involving minors. Attach additional lines, if necessary.

Please retain a copy of this signed form for department records and scan a copy to The completed form must be submitted at least 2 (two)business days prior to the event. Thank you.

Signature of party validating compliance: ___________________________

Name Printed:____________________________


PDF version of this page to fill out

Title IX Coordinator

Robert Pool
Vice President of Student Affairs
244 Hawkins-Conard Student Center