SHADES Online Application Form

Stopping 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):*
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:

Dates:* June 22-26, 2015 -- 9:00AM-4:00PM
July 6-10, 2015 -- 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.

        

Sign Up for E-News

Facebook  Twitter  Google Plus  Instagram  pintrest 

Search