Optional Instructional or Experiential Learning Meetings

Office of the ProvostOptional Instructional or Experiential Learning Meetings

This form is used to certify Optional Instructional or Experiential Learning Meetings or Events taking place on or off campus in order to ensure that all guidance from Federal, State, City and CUNY entities is being followed for the safety of all participants.

Please submit at least seven days prior to your scheduled meeting. One form is sufficient for a class that will have multiple meetings.

Course Information
Instructor Name Instructor Name * First Last
Instructor Email *
Course Name *
Course Section *
Cohort or Group *
School *
Meeting Information Details
Date of Activity Date of Activity * / MM / DD YYYY
Location of Activity Location of Activity *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Estimated Start Time Estimated Start Time * : HH MM AM/PM
Estimated End Time Estimated End Time * : HH MM AM/PM
Will this be a recurring event throughout the semester OR a one time excursion? *

Will this be a recurring event throughout the semester OR a one time excursion? Recurring event One time excursion
If a recurring event, specify future dates here:
Responsible Party

The responsible party is the person accompanying the students to the meeting/event. This person is responsible for ensuring compliance. May be the same as the instructor.
Name Name * First Last
Email *
Cell Number Cell Number * - ### - ### ####
Learning Meetings Information
Please select the choice or choices that best describe your excursion or meeting: *

Please select the choice or choices that best describe your excursion or meeting: Off campus (outdoor) Off campus (at a venue) On campus under tents (as capacity allows) On campus indoors (as capacity allows) Classroom or labs Other Other
Provide a rationale for conducting an optional instructional meeting or event. *
Risk Mitigation
I have read and will comply with the most current documents available at hunter.cuny.edu/fof: *

I have read and will comply with the most current documents available at hunter.cuny.edu/fof: COVID Training Available on Blackboard Instructional Safety Plan Use of the Everbridge App Health screening

In order to accompany students on any on-campus or off-campus event, please affirm that you understand and will implement Hunter protocols for the following items when in common areas: *
	I affirm that I understand and will implement Hunter protocols.
Physical Distancing (6 feet per student)	Physical Distancing (6 feet per student)
Personal Protective Equipment (PPE)	Personal Protective Equipment (PPE)
Hygiene, Cleaning, and Disinfection	Hygiene, Cleaning, and Disinfection
Communication Plan for Students	Communication Plan for Students
Limiting Capacity	Limiting Capacity

Physical Distancing Plan: Provide a description of your strategy for achieving physical distancing at site. You may enter “following the on-site guidelines" if there is a plan on file (i.e. Metropolitan Museum of Art Safety Guidelines — https://www.metmuseum.org/about-the-met/policies-and-documents/visitor-guidelines). *
Personal Protective Equipment (PPE) Plan: Provide a description of how you will carry extra masks in case participants show up without one and require all participants to wear a mask as a requirement for participation. *
Cleaning and Disinfection Plan: Provide a description of how you will maintain a clean environment throughout the event. This might include having hand sanitizer available at all times, wiping down shared surfaces with anti-bacterial wipes, etc. *
Communication Plan for Students: Describe the plan to ensure that participants are informed about health screening protocols and that they adhere to requirements for face coverings, social distancing, and hand hygiene. *
Limiting Capacity: How will you ensure you are limiting capacity for the event/excursion? *
High Risk Activities
This event will NOT include any high risk activities such as eating, drinking, singing, dancing, and use of musical instruments.

This event will NOT include any high risk activities such as eating, drinking, singing, dancing, and use of musical instruments.
If high risk activities are involved, please explain protocols to minimize risks.
Attestation
I understand that I am accountable for maintaining the safety standards in accordance with current recommendations. By submitting this form, I agree to follow NYS, CUNY, and Hunter Colleges guidelines and procedures. *

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Name of Person Submitting Form: Name of Person Submitting Form: * First Last
Date of Submission: Date of Submission: * / MM / DD YYYY

Optional Instructional or Experiential Learning Meetings

Office of the ProvostOptional Instructional or Experiential Learning Meetings

Course Information

Meeting Information Details

Responsible Party

Learning Meetings Information

Risk Mitigation

High Risk Activities

Attestation