Request for Exemption from Certain Requirements in MTSU Policy I:01:07 Minors
Participating in University-Sponsored Programs or Programs Using University Facilities
Name of Event:
__________________________________________________________
Date(s) of Event:
__________________________________________________________
Event Sponsor:
__________________________________________________________
Event Program Director: ______________________________________________________
Phone Number and Email Address: ______________________________________________
Pursuant to Section II.E. of MTSU Policy I:01:07 Minors Participating in University-Sponsored
Programs or Programs Using University Facilities, I am requesting an exemption(s) from the
following policy provision(s): [Insert provision(s) including the Section and Letter Number for which
you are requesting exception(s)]:
____________________________________________________________________________
____________________________________________________________________________
I am requesting this(these) exemption(s) for the following reasons [Insert reason(s) for the
request]:
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
If granted, the ______________________________ (Name of Program or Activity) will take the
following steps to protect minors [Insert alternative arrangements to protect minors if granted an
exemption]:
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____ Approved
____ Not Approved
Rev. 2/16
______________________________________________
President or Designee