Museum of Tolerance

Please Provide Your Contact Information

We will begin to plan your Tools for Tolerance program(s) after this form has been completed. Your information will be confidential and used to help us design the program for your school/organization.

Contact Information

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Name:

First Name Required	Last Name Required

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Email: Required

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Street 1: Required

Street 2:

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City/State/ZIP:

City Required	State Required	ZIP Required

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Phone Number: Required

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Question - Required - Title/Position:

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Question - Required - School/Other:

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Question - Required - School District / Region:

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Question - Required - County

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Question - Required - Cell Phone

Question - Not Required - Website

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Question - Required - Alternate Contact Person

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Question - Required - Alternate Contact Email

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Question - Required - Alternate Contact Cell Phone

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Question - Required - How did you learn about this opportunity? (Be specific, please):

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Question - Required - Interested in

a one-day program

a two-day program

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Question - Required - Preferred Date(s) 1

Month

Day

Year

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Question - Required - Preferred Date(s) 2

Month

Day

Year

Question - Not Required - Preferred Date(s) 3

Month

Day

Year

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Question - Required - What method of transportation will require the grant help cover?:

Airfare

Bus

Ground transportation

None

Question - Not Required - If flying, please identify a major airport closest to you.:

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Question - Required - Total # of Participants (minimum 30 people)

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Question - Required - Please describe your participating group (racial, ethnic, gender, socio-economic status, ages, religions, etc.)

(Maximum response 255 chars, approx. 5 rows of text)

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Question - Required - What is the composition of your group (mostly either classroom teachers, administrators, classified staff, a mixed group, etc.)?

(Maximum response 255 chars, approx. 5 rows of text)

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Question - Required - Describe any on-going/previous professional development training related to campus climate, diversity, social justice, etc.)

(Maximum response 255 chars, approx. 5 rows of text)

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Question - Required - Please indicate the provider(s) of the aforementioned professional development training (if applicable)

(Maximum response 255 chars, approx. 5 rows of text)

Question - Not Required - How does this professional development program fit into larger plans and strategic goals of your educator team?

(Maximum response 255 chars, approx. 5 rows of text)

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Question - Required - What do you see as some of the challenges facing your school community that could be addressed in this program?

(Maximum response 255 chars, approx. 5 rows of text)

Question - Not Required - Sign up for our eNewsletter!

Museum of Tolerance Updates

Program Goals

This program includes exploration of Museum exhibits, facilitated dialogue and discussion, special speakers and customized workshops. Please choose the content area you would most like to explore further and select the focus for your workshop:

A. Creating a positive and inclusive school climate: Best suited for educator teams; including teachers, classified staff, administrators, counselors, etc. This program could include content on cultural proficiency; addressing equity, bullying prevention, restorative justice, hate and bias; leadership development, etc.

B. Curriculum Transformation through a Social Justice Lens: Best suited for classroom teachers this program could focus on Common Core, teaching the history of the Holocaust, thematic model lessons, service learning, media literacy, etc.

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Question - Required - Choose

Creating a positive and inclusive school climate

Curriculum Transformation through a Social Justice Lens

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Question - Required - Please explain your choice & goals

(Maximum response 255 chars, approx. 5 rows of text)

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 registration has been submitted, not a confirmation of your program.

We will send you confirmation materials upon review of your registration. If you do not hear from us please contact educators@museumoftolerance.com to confirm that your information was received.

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

Tools for Tolerance for Educators