SHADES Application

Stop 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 7):
1. Name/Grade:
2. Name/Grade:
3. Name/Grade:
4. Name/Grade:
5. Name/Grade:
6. Name/Grade:
7. Name/Grade:
Simon Wiesenthal Center Updates: Yes
No

Please select the preferred program date:

First Choice:*
Second Choice:*

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.