Non-Discrimination Sign-Off Form

This form should be completed annually by 4-H leaders and others who are gatekeepers for our programs. A gatekeeper is a person who can decide who can attend or participate in a club or in a workshop and who might be granted an accommodation and who might not. Also any entities that are advisory to our programs, like an Executive Committee. Lastly, if a programmer collaborates in a substantial way with another entity that entity should complete a sign-off. Please do not hesitate to contact Beth Hawkyard at beth.hawkyard@maine.edu with questions.

• Assurance of Non-Discrimination Form (Word)
• Assurance of Non-Discrimination Form (PDF)

Please print and distribute the above form, have it signed and place in your office Civil Rights folder.

For more information about UMaine Extension’s civil rights policies, see Section 3.5 Civil Rights/Equal Employment Opportunity Guidelines.