North Dakota 4-H Youth Protection Policy: Forms

Center for 4-H Youth Development
Room 219 Family Life Center (FLC)
P.O. Box 5016
North Dakota State University
Fargo, ND 58105-5016
Phone: 701-231-7251
Fax: 701-231-8568
Email: Center for 4-H Youth Development

Youth Protection Policy

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Printer-Friendly (PDF) version of Staff Youth Protection Policy

Form Q	Check List for Implementation of the NDSU Extension Service Youth Protection Policy
Form A	Adult Behavior Expectations (new/current volunteers, keep a copy)
Form B	Application to Volunteer in Youth Programs (new volunteers, keep a copy)
Form C	Volunteer Information (current volunteers for re-certification, keep copy)

Form E	Reference Check by Telephone or Face-to-Face Interview (new volunteers)
Form F	Reference Check by Mail (new volunteers)
Form G	Request for Volunteer Screening Information From Another Agency
Form H	Confidentiality Statement (anyone who works with youth protection index files)
Form I	Volunteer Interview Report (new volunteers)
Form J	Report of Suspected Child Abuse or Neglect - ND Department of Human Services
Form K	Application Log (management tool)
Form M	Youth Protection Policy Form: Prospective Employees - County-Paid Staff (keep copy)
Form N	Youth Protection Policy Form: Prospective Employees (keep copy)
Form O	Youth Protection Policy Form: Current State-Paid Employees (keep copy)
Form P	Youth Protection Policy Form: Current County-Paid Employees (keep copy)

December 2001
Revised, August 2002

Please direct your questions to:

Brad Cogdill, Chair
Center for 4-H Youth Development
Family Life Center 219, Box 5016
Fargo, ND 58105-5016
Phone (701)231-7253
FAX (701)231-8568

Youth Protection Policy: Staff