TEENS
TALK ABOUT RACISM
WORKSHOP
APPLICATION FORM
SCHOOL NAME:____________________________
WORKSHOP TITLE: _________________________
WORKSHOP DESCRIPTION:
_____________________________________________________________________________________________________________________________________________________________________________________________________________
STUDENT CONTACT #1:
Name: _____________________________________
Phone Number:_______________________________
E-Mail Address:______________________________
STUDENT CONTACT #2:
Name: _____________________________________
Phone Number: ______________________________
E-Mail Address: ______________________________
TEACHER/ADULT
ADVISOR:
Name/Title:_________________________________
Phone Number: ______________________________
E-Mail Address: ______________________________
WHEN COMPLETED, MAIL OR E-MAIL THE INFORMATION TO: