R-COOL-Health Scrubs Camps – Important Forms and Documents

Forms for Site Coordinators

• Memorandum of Agreement
• Site Coordinator Guide
• Site Coordinator Checklist
• Student Participant Roster Form*
• Student Evaluation Form**
• Scrubs Order Form*
• Allowable and Unallowable Expenses
• Sample Invoice
• Photo/Video & Evaluation Waiver***
• News Release Form

* This exact form is required for submission to the Center for Rural Health
** Parts A & C required
*** These exact statements must be asked and signed by the parents

Sample Camp Materials

• Agenda
• Confidentiality Agreement Form (Sample) | pdf
• Student Application Form | pdf

Sample Promotional Materials

• Document header
• Penguin graphic
• CRH logo
• Promotional Poster Template

Materials to Use for Parents/Students/School Administrators

• Health Careers Flyer for Grades 5-12
• Parent Letter (Sample) | pdf
• Job Shadowing Application Form | pdf
• Reasons for Collecting Contact Information | pdf

Forms for Presenters

• Presenter Evaluation | pdf
• Presenter Information Form (Sample) | pdf
• Presenter Q & A
• HIPAA Certification Test

For more information, contact:
Nicole Threadgold
Grant Program Director
nicole.threadgold@UND.edu
(701) 330-3264