Non-Discrimination Sign-Off Form

This form should be completed annually by individuals and groups 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 accommodation and who might not.

Who should complete this form?

• All Extension volunteers including 4-H, Master Gardeners, and County Executive Committee members, Advisory Board members (such as the 4-H Foundation).
• Substantial collaborators such as community partners including, but not limited to: farms, businesses, non-profits, community groups.

Please contact Alisha Targonski, alisha.r.targonski@maine.edu with questions.

• Assurance of Non-Discrimination Form (SharePoint)

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