This form must be completed by the PI, research associate, or the university employee responsible for supervising the minor intern. Your name: NetID: Department/Unit: Name of internship (please ensure this matches the program named entered in the Ideal-Logic registration system): Location(s) of the internship: Dates of the internship: Description of the internship: Is this internship in partnership with another Cornell department or an outside organization? If yes, please provide the name of the department or organization. Will the internship involve the use of any of the following equipment: Radiation-producing equipment Lasers Machinery Tools that present electrical, pressure, temperature, ultraviolet, and/or other physical hazards All of the above None of the above Will the internship involve the use of any of the following materials: Chemicals Biological agents Radioactive materials Compressed gases Cryogenic liquids Other materials that present a health and/or physical hazard All of the above None of the above Who is responsible for providing the youth training on hazardous materials and equipment? What PPE will be required? Will the internship include any field trips? If yes, please list all dates and locations and explain what activities will be conducted during the field trip(s). Where is the minor from? If the youth is not local, please explain their living arrangements and who will be responsible for them during non-internship hours. How will the minor be commuting to and from the internship? Does the minor have health insurance applicable to and during the internship period? I confirm that the 'Guidelines for Cornell Faculty and Staff Engaging with Interns and Visiting Students' have been reviewed. I confirm that I have consulted with my Human Resources office about hosting an intern who is a minor. I confirm that the 'Youth in Labs Guidelines' have been consulted.
