Museum of Tolerance

This workshop is designed as a 50-min classroom experience for grades 8-12

1.

Contact Information

*

Name:

First Name Required	Last Name Required

*

Email: Required

*

Street 1: Required

Street 2:

*

City/State/ZIP:

City Required	State Required	ZIP Required

*

Phone Number: Required

If you respond and have not already registered, you will receive periodic updates and communications from Simon Wiesenthal Center.

*2.

Question - Required - Position/Title:

*3.

Question - Required - School / Organization:

*4.

Question - Required - Grade level [s]

*5.

Question - Required - Preferred Date 1:

Month

Day

Year

6.

Question - Not Required - Preferred Date 2:

Month

Day

Year

7.

Question - Not Required - Preferred Date 3:

Month

Day

Year

*8.

Question - Required - Requested Arrival Time:

*9.

Question - Required - Total Number of students

*10.

Question - Required - Average class size:

*11.

Question - Required - By selecting yes, I confirm my school has AV resources including a computer, projector and screen, which Combat Hate facilitators can access to deliver the program

*12.

Question - Required - How did you hear about this program?

*13.

Question - Required - What do you expect your students to gain from this program?

14.

Question - Not Required - Additional comments:

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