Appendix F
Background Check and Protection of Minors Training
Attestation Form for Third Party Programs at Lehigh University
All capitalized terms not defined herein shall have the meanings set forth in the Lehigh University Protection of Minors Policy (the “Policy”).
By signing below, pursuant to the Policy, and on behalf of ______________________ [organization name] (“Organization”), I hereby attest, represent and agree that:
1) All officers, employees, volunteers, representatives and agents of the Organization who may have Direct Contact with Minors in connection with the Organization’s Program at Lehigh University:
(a) have undergone a satisfactory criminal background check in accordance with applicable law (including without limitation the Pennsylvania Child Protective Services Law), either within the timeframe required by applicable law or within the last 12 months (if this is the first time the individual has participated in a Program at Lehigh University);
(b) have not notified the Organization of an arrest or conviction that would constitute grounds for denying employment or participation in the Organization’s Program, or of being named as a perpetrator in a founded or indicated report, and that Organization has no reasonable belief that any such events have occurred;
(c) have completed training on child protection in accordance with Section 7 of the Policy and which, at a minimum, covers the following topics: basic warning signs of abuse or neglect of Minors; guidelines for protecting Minors from emotional and physical abuse and neglect; and requirements and procedures for reporting incidents or suspected abuse or neglect or improper conduct.
2) Upon Lehigh University’s request, the Organization shall promptly provide documentation in form and substance reasonably satisfactory to Lehigh University evidencing the Organization’s compliance with the Policy, including the above statements.
ORGANIZATION
__________________________________
Signature
______________________________
Print Name
______________________________
Print Title
______________________________
Date