Survey - Virtual Programs for Students - Simon Wiesenthal Center

After this profile form is completed and returned we will begin to plan your Tools for Tolerance® program(s).

This profile will be confidential and only be used to help us design the program for your organization. This information helps orient our facilitation staff to your specific needs and concerns in order to make your program as meaningful and practical as possible. We encourage student participation in completing portions of this profile.

Contact Information

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Name:

First Required	Last 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

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

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Question - Required - Position/Title:

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Question - Required - School / Organization:

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Question - Required - Preferred Date 1:

Month

Day

Year

Question - Not Required - Preferred Date 2:

Month

Day

Year

Question - Not Required - Preferred Date 3:

Month

Day

Year

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Question - Required - Total Number of students, grades 7 -12, including Adult Chaperones who plan to attend the MOT experience.:

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Question - Required - DEMOGRAPHICS: Please provide student background info to help us better serve your group. (racial, ethnic background,gender,age,religion,etc.):

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Question - Required - Assurance Statement: I have read the FAQ, and understand the time and financial commitment required to participate in this program. Follow this link to the FAQ: www.museumoftolerance.com/TeensFAQ

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Question - Required - Select a program: Anne Frank: A Fascinating Look at the Real Anne
Youth Voices and Resistance During the Holocaust
Tolerancenter: Inside-Out Approach to Anti-Bias Education
Holocaust Survivor Personal Testimony
From the Depths of Hate: Personal Testimony
Lessons from Little Rock: Dr. Terrence Roberts