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SHADES Virtual Application

Stop Hate and Delinquency by Empowering Students (SHADES)

Virtual Teen Court Juror Institute presented by the Museum of Tolerance

Teen Court Coordinator 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

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Street 2: Required

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State/ZIP:

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 - District/Region:

SHADES Teen Court Juror Trainees (Maximum of 7): Please provide an email address that you have access to over the summer. We will need to send you links to the sessions and other confirmation materials.

Question - Not Required - 1. Name/Grade:

Question - Not Required - Email

Question - Not Required - 2. Name/Grade:

Question - Not Required - Email

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

Question - Not Required - 3. Name/Grade:

Question - Not Required - Email

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

Question - Not Required - 4. Name/Grade:

Question - Not Required - Email

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

Question - Not Required - 5. Name/Grade:

Question - Not Required - Email

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

Question - Not Required - 6. Name/Grade:

Question - Not Required - Email

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

Question - Not Required - 7. Name/Grade:

Question - Not Required - Email

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

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Question - Required - Let us know if there will be an adult participating with the students from your school. (Please provide both names and contact information for adults):

Question - Not Required - Subscribes to our updates:

	Museum of Tolerance Updates
	Simon Wiesenthal Center Updates

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 youthed@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.

By submitting this application I agree to the following assurance statement:

I understand that if my school is selected to attend the SHADES Teen Court Juror Institute, we are making a serious commitment of time and energy to the program and all related activities for the entire week. I have read the program overview and reviewed the course dates and can assure that we will attend all workshops and take part in all learning activities through active participation.