SJTI - Application Form

Social Justice Training Institute

SJTI II Registration

"A Renewal Experience for Alumni"
February 15 – 18, 2012
Ft. Lauderdale, FL

There will not be a selection process for this experience. It is open to all past SJTI participants. In order to assist us in developing the curriculum for the weekend and to get a sense of the profile of the participants, we ask you respond to the questions below. Due to financial considerations, we need a minimum of 25 participants to register and commit by October 28, 2011.

If you are only attending the Celebration, just complete the contact information and SJTI Class/location portions of the registration form.

Name:
Name of Institution or place of work:
Work Address (snail mail):
City, State & Zip Code:	,
Cell Phone:
Work Phone:
Work Fax:
Work E-mail:
SJTI Class/Location:
Sex/Gender Identity:
How do you identify Racially/Ethnically?
Sexual Orientation:
Other identities you wish to share:
Are you attending the Celebration?
Are you ONLY attending the Celebration?
What key 'learnings' have you used since your institute experience? What continues to be your 'learning edges' or areas of growth? What would you like to see included in this renewal experience?

Full and Equal Participation of All Groups in Society