SHADES Online Application Form

Stop Hate and Delinquency by Empowering Students (SHADES)

Teen Court Juror Institute at the Museum of Tolerance

* required information
 

Teen Court Coordinator Contact Information:

First Name:*
Last Name:*
Position/Title:*
Email:*
Cell Phone:*
School / Organization:*
District/Region:*
Address Line 1:*
Address Line 2:
City:*
State:*
ZIP/Postal Code:*
Phone:*
Fax:
Adult Chaperone Information (Please provide both names and contact information for chaperones):*
Will you attend all 5 days and want to receive the $500 stipend? (Conditions apply. One per school.):* Yes
No
Will you share chaperone duties and want to split the stipend?:* Yes
No
SHADES Teen Court Juror Trainees (Maximum of 10):
1. Name/Grade:
2. Name/Grade:
3. Name/Grade:
4. Name/Grade:
5. Name/Grade:
6. Name/Grade:
7. Name/Grade:
8. Name/Grade:
9. Name/Grade:
10. Name/Grade:

Simon Wiesenthal Center Updates
:
Yes
No

Please select the preferred program date:

First Choice:*
Second Choice:*

PLEASE NOTE: Once you press the submit button, you will be taken to an automatic confirmation page. Please do not close your browser prior to this confirmation appearing, as it will cancel your submission.

This is only a confirmation that your application has been submitted, not a confirmation of your program.

We will send you confirmation materials upon review of your application. If you do not hear from us please contact edprograms@museumoftolerance.com to confirm that your application was submitted.

We recommend printing or saving the contents of this form for your records, in case of submission processing error.

        

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