Registration Form - "Teaching About the Holocaust" Educator Workshop - Augusta University - January 18-19, 2024

1 Educator Name

2 Mailing Address

Address

Address 2

City/Town

State

ZIP

3 Phone Number

4 Personal Email

5 School Email

6 I am a:

Current Teacher

Enrolled in a Teacher Program

If enrolled in a program, but not a classroom teacher, skip to Question 15.

7 School Name

8 School Address

Address

Address 2

City/Town

State

ZIP

9 School Type

Public

Private

Charter

Virtual

10 School District

11 School Student Body Size

12 Grade Level & Subject Currently Teaching

13 How many years have you taught the Holocaust?

How many days each year do you spend teaching the Holocaust?

What books/films or other resources do you currently or plan to use?

14 Will you require substitute reimbursement?

Yes

No

15 Name of College or University Currently Enrolled in (if applicable)

16 Program of Study (if applicable)

17 Anticipated grade level & subject(s) you plan to teach

18 How did you hear about this workshop?

19 List any dietary restrictions