SHADES Online Application Form

Stopping Hate and Delinquency by Empowering Students (S.H.A.D.E.S.)

Teen Court Juror Institute at the Museum of Tolerance

* required information
 

Teen Court Coordinator Contact Information:

First Name:*
Last Name:*
School / Organization:*
Position/Title:*
Email:*
Address Line 1:*
Address Line 2:
City:*
State:*
ZIP/Postal Code:*
Phone:*
Cell Phone:
Fax:
Would you like to inquire about scholarships for your students:* Yes
No
Adult Chaperone Information (Please provide both names and contact information for chaperones):*
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:

Please select the preferred program date:

Dates:* June 9-13, 2014 -- 9:00AM-4:00PM
June 16-20, 2014 -- 9:00AM-4:00PM

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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